Provider Demographics
NPI:1760150528
Name:MONTALVO, STEPHANIE LEA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEA
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 PARK DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-1122
Mailing Address - Country:US
Mailing Address - Phone:203-470-8175
Mailing Address - Fax:
Practice Address - Street 1:58 PARK DR
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-1122
Practice Address - Country:US
Practice Address - Phone:203-470-8175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-303851163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant