Provider Demographics
NPI:1689122806
Name:STRAWA, STEFANIE ANNE (MSED)
Entity Type:Individual
Prefix:MISS
First Name:STEFANIE
Middle Name:ANNE
Last Name:STRAWA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 DAFFODIL CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1643
Mailing Address - Country:US
Mailing Address - Phone:917-575-3469
Mailing Address - Fax:
Practice Address - Street 1:45 DAFFODIL CT
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1643
Practice Address - Country:US
Practice Address - Phone:917-575-3469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1075045161174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist