Provider Demographics
NPI:1891769014
Name:SLAUGHTER, STEPHANIE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANN
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5556 PINE LOCH LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2854
Mailing Address - Country:US
Mailing Address - Phone:716-568-2196
Mailing Address - Fax:
Practice Address - Street 1:5556 PINE LOCH LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2854
Practice Address - Country:US
Practice Address - Phone:716-568-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007401207L00000X
MDD0062161207L00000X
MA56124207L00000X
VA0101234131207L00000X
NY21712207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110043660AMedicaid
MA3013634Medicaid
MAJ06837Medicare ID - Type Unspecified