Provider Information for 1528571494
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STEPHANIE CHARLES
Sex: Female
NPI: 1528571494
Last Updated: 2024-04-05
Certification Date: 2024-04-05
Certification Date: 2024-04-05
Details
| Name | Value | ||||||||
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| NPI | 1528571494 | ||||||||
| Enumeration Date | 2017-11-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 220 STATE ST WESTBURY, NY 11590-3929 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 150 11TH AVE HUNTINGTON STATION, NY 11746-2250 United States Phone: 516-500-5717 | Fax: | ||||||||
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