Provider Demographics
NPI:1376785618
Name:PAPPAS, STEPHANIE MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:KOLB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:257 LAFAYETTE AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4830
Mailing Address - Country:US
Mailing Address - Phone:845-369-9100
Mailing Address - Fax:845-369-6738
Practice Address - Street 1:257 LAFAYETTE AVENUE
Practice Address - Street 2:SUITE 120
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-369-9100
Practice Address - Fax:845-369-6738
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
003262-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant