Provider Demographics
NPI:1508566845
Name:BRASSIL, STEPHANIE DAWN TERESA (AGNP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DAWN TERESA
Last Name:BRASSIL
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DAWN TERESA
Other - Last Name:MAGNANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP
Mailing Address - Street 1:121 CEDAR POINT DR
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-5033
Mailing Address - Country:US
Mailing Address - Phone:631-374-9588
Mailing Address - Fax:
Practice Address - Street 1:121 CEDAR POINT DR
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-5033
Practice Address - Country:US
Practice Address - Phone:631-374-9588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310932-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health