Provider Demographics
NPI:1093968323
Name:SPEAR, STEPHANIE J (RPA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:SPEAR
Suffix:
Gender:F
Credentials:RPA-C
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Other - Credentials:
Mailing Address - Street 1:400 PATROON CREEK BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-5013
Mailing Address - Country:US
Mailing Address - Phone:518-489-0044
Mailing Address - Fax:518-489-3591
Practice Address - Street 1:400 PATROON CREEK BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-5013
Practice Address - Country:US
Practice Address - Phone:518-489-0044
Practice Address - Fax:518-489-3591
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2019-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY005764363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03226955Medicaid
NYP01316384OtherRAILROAD MEDICARE
NY03226955Medicaid