Provider Demographics
NPI:1740924026
Name:MYRICKS, STEPHANIE K
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:MYRICKS
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 1:25 ROSALIND ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2121
Mailing Address - Country:US
Mailing Address - Phone:585-284-0687
Mailing Address - Fax:
Practice Address - Street 1:25 ROSALIND ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-2121
Practice Address - Country:US
Practice Address - Phone:585-284-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle