Provider Demographics
NPI:1417510868
Name:STOKES, DEIRDRE PATRICIA (DO)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:PATRICIA
Last Name:STOKES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BEACH 214TH ST
Mailing Address - Street 2:
Mailing Address - City:BREEZY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11697-1638
Mailing Address - Country:US
Mailing Address - Phone:718-679-0435
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL RD STE 115
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8811
Practice Address - Country:US
Practice Address - Phone:631-228-5801
Practice Address - Fax:929-455-9827
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty