Provider Demographics
NPI:1114212537
Name:RUSSO, STEPHANIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WESTAGE BUSINESS CTR DR
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2219
Mailing Address - Country:US
Mailing Address - Phone:845-897-3059
Mailing Address - Fax:845-897-3254
Practice Address - Street 1:18 WESTAGE BUSINESS CTR DR
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2219
Practice Address - Country:US
Practice Address - Phone:845-897-3059
Practice Address - Fax:845-897-3254
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002335231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist