Provider Demographics
NPI:1780071498
Name:CHIAO, STEPHANIE KAY
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:CHIAO
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 1:4285 PAYNE AVE # 9827
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-3324
Mailing Address - Country:US
Mailing Address - Phone:201-472-5029
Mailing Address - Fax:
Practice Address - Street 1:253 SOUTH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7827
Practice Address - Country:US
Practice Address - Phone:212-720-4540
Practice Address - Fax:212-732-9754
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1830702084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry