Provider Demographics
NPI:1003562489
Name:LANDELL, STEPHEN CONSTANTINE (RN)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CONSTANTINE
Last Name:LANDELL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ARLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1206
Mailing Address - Country:US
Mailing Address - Phone:914-513-4200
Mailing Address - Fax:
Practice Address - Street 1:1305 WALT WHITMAN RD FL 3
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4300
Practice Address - Country:US
Practice Address - Phone:516-945-3374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY648718163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty