Provider Demographics
NPI:1528606282
Name:RUSSO, STEFFANI M
Entity Type:Individual
Prefix:
First Name:STEFFANI
Middle Name:M
Last Name:RUSSO
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 1:3058 BAILEY AVE APT 2S
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5820
Mailing Address - Country:US
Mailing Address - Phone:347-839-3416
Mailing Address - Fax:
Practice Address - Street 1:3058 BAILEY AVE APT 2S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5820
Practice Address - Country:US
Practice Address - Phone:347-839-3416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist