Provider Demographics
NPI:1518361856
Name:STAUB, RACHAEL ELIZABETH (MS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:ELIZABETH
Last Name:STAUB
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:MS
Other - First Name:RACHAEL
Other - Middle Name:ELIZABETH
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:7 VERMONT DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-210-8400
Mailing Address - Fax:516-210-8494
Practice Address - Street 1:160 ROBBINS ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2652
Practice Address - Country:US
Practice Address - Phone:203-573-7284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017874207XP3100X, 363AS0400X
CT3430363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery