Provider Demographics
NPI:1659482438
Name:ZERONDA, STEPHANIE W (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:W
Last Name:ZERONDA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 NEW SCOTLAND RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9222
Mailing Address - Country:US
Mailing Address - Phone:518-439-2460
Mailing Address - Fax:518-439-3025
Practice Address - Street 1:1240 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9222
Practice Address - Country:US
Practice Address - Phone:518-439-2460
Practice Address - Fax:518-439-3025
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010509363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY786425OtherMVP HEALTHCARE
NY02634586Medicaid
NY000408559001OtherBSNENY
NY070418000040OtherFIDELIS
NYPA0757Medicare ID - Type Unspecified
NY786425OtherMVP HEALTHCARE