Provider Demographics
NPI:1598088155
Name:STUBBS, CANDIE LYNN (MT)
Entity Type:Individual
Prefix:MISS
First Name:CANDIE
Middle Name:LYNN
Last Name:STUBBS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BROOKIDGE DR.
Mailing Address - Street 2:32 BROOKRIDGE DR.
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075
Mailing Address - Country:US
Mailing Address - Phone:716-880-9237
Mailing Address - Fax:
Practice Address - Street 1:787 DELAWARE AVE
Practice Address - Street 2:787 DELAWARE AVE.
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2005
Practice Address - Country:US
Practice Address - Phone:716-886-3145
Practice Address - Fax:716-961-0863
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022764225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist