Provider Demographics
NPI:1861657074
Name:ALVARADO, STEPHANIE L (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:L
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:LANGONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA--C
Mailing Address - Street 1:16303 HORACE HARDING EXPY
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1454
Mailing Address - Country:US
Mailing Address - Phone:718-670-1170
Mailing Address - Fax:
Practice Address - Street 1:16303 HORACE HARDING EXPY
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1454
Practice Address - Country:US
Practice Address - Phone:718-670-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant