Provider Demographics
NPI:1689879918
Name:STEVENSON, LALITA
Entity Type:Individual
Prefix:
First Name:LALITA
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 SIMPSON PL
Mailing Address - Street 2:APT 7
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-4522
Mailing Address - Country:US
Mailing Address - Phone:914-804-1391
Mailing Address - Fax:
Practice Address - Street 1:338 SIMPSON PL
Practice Address - Street 2:APT 7
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-4522
Practice Address - Country:US
Practice Address - Phone:914-804-1391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286497-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02872291Medicaid