Provider Demographics
NPI:1992085138
Name:DESMARAIS, STEPHANIE (RPA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:DESMARAIS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 NEW SCOTLAND RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9386
Mailing Address - Country:US
Mailing Address - Phone:518-439-4326
Mailing Address - Fax:
Practice Address - Street 1:1220 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9386
Practice Address - Country:US
Practice Address - Phone:518-439-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015032363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant