Provider Demographics
NPI:1790134500
Name:NEVES, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:NEVES
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 1:515 MADISON AVE
Mailing Address - Street 2:RM 2310
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5430
Mailing Address - Country:US
Mailing Address - Phone:917-513-8537
Mailing Address - Fax:
Practice Address - Street 1:36-11 21ST STREET
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4505
Practice Address - Country:US
Practice Address - Phone:718-482-7772
Practice Address - Fax:718-482-9648
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY686668163W00000X
NYF402088363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
WI331944Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
WI331946Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
WI331978Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
WI331945Medicare Oscar/Certification
WI331952Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
WI331043Medicare Oscar/Certification
WI331058Medicare Oscar/Certification
WI331943Medicare Oscar/Certification
WI331947Medicare Oscar/Certification