Provider Demographics
NPI:1407116817
Name:VENTURA, STEPHANIE A (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:VENTURA
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 1:1150 PORTION RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1074
Mailing Address - Country:US
Mailing Address - Phone:631-732-1024
Mailing Address - Fax:631-803-2201
Practice Address - Street 1:1150 PORTION RD
Practice Address - Street 2:SUITE 17
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1074
Practice Address - Country:US
Practice Address - Phone:631-732-1024
Practice Address - Fax:631-803-2201
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist