Provider Demographics
NPI:1659025633
Name:CHESNICK, STACY ALISE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ALISE
Last Name:CHESNICK
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6251 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8714
Mailing Address - Country:US
Mailing Address - Phone:315-699-9595
Mailing Address - Fax:
Practice Address - Street 1:6251 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8714
Practice Address - Country:US
Practice Address - Phone:315-699-9595
Practice Address - Fax:315-699-7095
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10125363LF0000X
CA95015142363LF0000X
NY351849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily