Provider Demographics
NPI:1700360971
Name:NGUYEN, STEPHANIE LUU (LAC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LUU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 W SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2225
Mailing Address - Country:US
Mailing Address - Phone:315-571-6641
Mailing Address - Fax:
Practice Address - Street 1:4922 W SENECA TPKE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2225
Practice Address - Country:US
Practice Address - Phone:315-857-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006340171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist