Provider Demographics
NPI:1558621029
Name:STACHELEK, MARY E
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:STACHELEK
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 1:501 E FAYETTE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1953
Mailing Address - Country:US
Mailing Address - Phone:315-435-3230
Mailing Address - Fax:315-435-2678
Practice Address - Street 1:501 E FAYETTE ST
Practice Address - Street 2:SUITE B
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1953
Practice Address - Country:US
Practice Address - Phone:315-435-3230
Practice Address - Fax:315-435-2678
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator