Provider Demographics
NPI:1750750881
Name:STEVENSON, SARA W (NP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:W
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX #1165
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-241-7181
Mailing Address - Fax:212-426-5107
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:BOX #1165
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-241-7181
Practice Address - Fax:212-426-5107
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2020-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY746823163W00000X
NYF402354363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008003745Medicaid
CT008073748Medicaid
CT004041000Medicaid
CT008068669Medicaid
NY05145208Medicaid