Provider Demographics
NPI:1275224537
Name:PICHARDO, STEPHANIE MARIE (CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:PICHARDO
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 35TH AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1972
Mailing Address - Country:US
Mailing Address - Phone:347-701-0359
Mailing Address - Fax:
Practice Address - Street 1:1411 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4512
Practice Address - Country:US
Practice Address - Phone:718-907-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383508208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics