Provider Demographics
NPI:1073037032
Name:SCHOENBACH, STACY H (NP)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:H
Last Name:SCHOENBACH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BROADHOLLOW RD STE 207
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4806
Mailing Address - Country:US
Mailing Address - Phone:631-707-2394
Mailing Address - Fax:631-824-9118
Practice Address - Street 1:200 BROADHOLLOW ROAD
Practice Address - Street 2:SUITE 207
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747
Practice Address - Country:US
Practice Address - Phone:631-707-2394
Practice Address - Fax:631-824-9118
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402177-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE