Provider Demographics
NPI:1700394350
Name:STEPHANY, KYRSTEN M (AUD)
Entity Type:Individual
Prefix:MRS
First Name:KYRSTEN
Middle Name:M
Last Name:STEPHANY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KYRSTEN
Other - Middle Name:M
Other - Last Name:STAPHANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:103 CANAL LANDING BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-5108
Mailing Address - Country:US
Mailing Address - Phone:585-723-3440
Mailing Address - Fax:585-735-4632
Practice Address - Street 1:103 CANAL LANDING BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5108
Practice Address - Country:US
Practice Address - Phone:585-723-3440
Practice Address - Fax:585-735-4632
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002722-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist