Provider Demographics
NPI:1144584111
Name:ATAMANCHUK, STEPHANIE EVA (MS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:EVA
Last Name:ATAMANCHUK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:EVA
Other - Last Name:BURCHARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 SWEET RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1723
Mailing Address - Country:US
Mailing Address - Phone:518-260-4907
Mailing Address - Fax:
Practice Address - Street 1:30 SWEET RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1723
Practice Address - Country:US
Practice Address - Phone:518-260-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist