Provider Demographics
NPI:1093048647
Name:STANLEY, MARYANN (MS SP ED)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MS SP ED
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:
Other - Last Name:CUOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SPED
Mailing Address - Street 1:2540 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1535
Mailing Address - Country:US
Mailing Address - Phone:631-678-3596
Mailing Address - Fax:
Practice Address - Street 1:94 LOCUST PL
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1491
Practice Address - Country:US
Practice Address - Phone:631-754-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No385H00000XRespite Care FacilityRespite Care