Provider Demographics
NPI:1497017644
Name:BIANCO, STEPHANIE A (MSED)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:BIANCO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 DELAFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2606
Mailing Address - Country:US
Mailing Address - Phone:646-662-7672
Mailing Address - Fax:
Practice Address - Street 1:108 DELAFIELD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2606
Practice Address - Country:US
Practice Address - Phone:646-662-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist