Provider Demographics
NPI:1235856873
Name:MCCORMICK, STEPHANY (LMT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANY
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3868 E ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2001
Mailing Address - Country:US
Mailing Address - Phone:716-564-2225
Mailing Address - Fax:888-484-2163
Practice Address - Street 1:3868 E ROBINSON RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14228-2001
Practice Address - Country:US
Practice Address - Phone:716-564-2225
Practice Address - Fax:888-484-2163
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026600-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist