Provider Demographics
NPI:1346503265
Name:MCSHEA, STEPHANIE RUTLEDGE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RUTLEDGE
Last Name:MCSHEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RUTLEDGE
Other - Last Name:VONDER LINDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:52 ARGYLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1702
Mailing Address - Country:US
Mailing Address - Phone:516-505-1913
Mailing Address - Fax:
Practice Address - Street 1:52 ARGYLE RD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1702
Practice Address - Country:US
Practice Address - Phone:516-505-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist