Provider Demographics
NPI:1417219411
Name:STAULCUP, RACHEL ALYSSA (MS)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ALYSSA
Last Name:STAULCUP
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 JEANNE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1701
Mailing Address - Country:US
Mailing Address - Phone:845-566-3419
Mailing Address - Fax:
Practice Address - Street 1:34 JEANNE DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1701
Practice Address - Country:US
Practice Address - Phone:845-566-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY657026951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist