Provider Demographics
NPI:1407274269
Name:MAYFIELD, STEPHANIE G (MS OTR/L)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:G
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8615 AVA PL
Mailing Address - Street 2:1H
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2900
Mailing Address - Country:US
Mailing Address - Phone:917-941-7656
Mailing Address - Fax:
Practice Address - Street 1:8615 AVA PL
Practice Address - Street 2:1H
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2900
Practice Address - Country:US
Practice Address - Phone:917-941-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-30
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018745171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor