Provider Demographics
NPI:1689198376
Name:CONDON, STEPHANIE ELIZABETH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:CONDON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:ELIZABETH
Other - Last Name:GIOIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:8390 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SODUS
Mailing Address - State:NY
Mailing Address - Zip Code:14551-9519
Mailing Address - Country:US
Mailing Address - Phone:585-775-9637
Mailing Address - Fax:
Practice Address - Street 1:8390 RIDGE RD
Practice Address - Street 2:
Practice Address - City:SODUS
Practice Address - State:NY
Practice Address - Zip Code:14551-9519
Practice Address - Country:US
Practice Address - Phone:585-775-9637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299454164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY299454Medicaid