Provider Demographics
NPI:1639156318
Name:STEHLIN, MURIEL GAIL (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MURIEL
Middle Name:GAIL
Last Name:STEHLIN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-0650
Mailing Address - Fax:631-638-4170
Practice Address - Street 1:3 TECHNOLOGY DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:E. SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:631-444-5237
Practice Address - Fax:631-444-5225
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004804-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S77250Medicare UPIN