Provider Demographics
NPI:1528604741
Name:STAFFORD, FREDERICK W III
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:W
Last Name:STAFFORD
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 FARM TO MARKET RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-9054
Mailing Address - Country:US
Mailing Address - Phone:518-512-2714
Mailing Address - Fax:
Practice Address - Street 1:310 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1017
Practice Address - Country:US
Practice Address - Phone:518-463-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner