Provider Demographics
NPI:1801045984
Name:STAVOLA, THERESA LORRAINE (ANP)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LORRAINE
Last Name:STAVOLA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HSC T16-080 NICHOLLS RD DEPT OF INTERNAL MEDICINE
Mailing Address - Street 2:DIV OF CARDIOLOGY SUNY STONY BROOK UNIVERSITY HOSPITAL
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794
Mailing Address - Country:US
Mailing Address - Phone:631-444-1066
Mailing Address - Fax:
Practice Address - Street 1:HSC T16-080 NICHOLLS RD DEPT OF INTERNAL MEDICINE
Practice Address - Street 2:DIV OF CARDIOLOGY SUNY STONY BROOK UNIVERSITY HOSPITAL
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794
Practice Address - Country:US
Practice Address - Phone:631-444-1066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301910363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health