Provider Demographics
NPI:1679824908
Name:FERNANDEZ, STEPHANIE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SUSINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:465 SOUTH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6442
Mailing Address - Country:US
Mailing Address - Phone:973-695-4726
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:901 W MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-677-1091
Practice Address - Fax:732-431-4640
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015963363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant