Provider Demographics
NPI:1639591654
Name:STEPHENS, MAUREEN C
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:C
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:C
Other - Last Name:OPARAJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17417 129TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-5806
Mailing Address - Country:US
Mailing Address - Phone:347-358-0125
Mailing Address - Fax:718-723-4978
Practice Address - Street 1:17417 129TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5806
Practice Address - Country:US
Practice Address - Phone:347-358-0125
Practice Address - Fax:718-723-4978
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY536549111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist