Provider Demographics
NPI:1508955402
Name:FYNN-AIKINS, STEFANIA (PMH NP)
Entity Type:Individual
Prefix:MS
First Name:STEFANIA
Middle Name:
Last Name:FYNN-AIKINS
Suffix:
Gender:F
Credentials:PMH NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4985 HARLEM ROAD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-839-0500
Mailing Address - Fax:716-839-0523
Practice Address - Street 1:4985 HARLEM ROAD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-839-0500
Practice Address - Fax:716-839-0523
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY501436-1163W00000X
NYF401043363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF401043OtherPSYCHIATRIC NURSE
NY501436-1OtherRN
NY00594876Medicaid