Provider Demographics
NPI:1265258198
Name:STEVENS, MEREDITH CLAIR
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:CLAIR
Last Name:STEVENS
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 1:63 MYANO LN APT 2
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4535
Mailing Address - Country:US
Mailing Address - Phone:914-874-7216
Mailing Address - Fax:
Practice Address - Street 1:40 SAW MILL RIVER RD STE FB1
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1528
Practice Address - Country:US
Practice Address - Phone:914-358-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF383720-01363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics