Provider Demographics
NPI:1508423153
Name:EPPERSON, STEPHANIE COLETTE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:COLETTE
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 CROWELL ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-5117
Mailing Address - Country:US
Mailing Address - Phone:516-710-9578
Mailing Address - Fax:
Practice Address - Street 1:15053 14TH RD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2656
Practice Address - Country:US
Practice Address - Phone:516-730-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000000OtherNON MEDICAL