Provider Demographics
NPI:1629011796
Name:YU, STEPHANIE N (PA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:N
Last Name:YU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HIGHWAY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-383-8830
Mailing Address - Fax:585-383-8918
Practice Address - Street 1:360 LINDEN OAKS
Practice Address - Street 2:SUITE #300
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2814
Practice Address - Country:US
Practice Address - Phone:585-383-8830
Practice Address - Fax:585-383-8918
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009164363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00337678OtherMEDICARE TRAVELERS
NY02782483Medicaid
NY02782483Medicaid