Provider Demographics
NPI:1841464823
Name:DELAHUNT, STEPHANIE L (LMT, PTA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:L
Last Name:DELAHUNT
Suffix:
Gender:F
Credentials:LMT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WYNNFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-2924
Mailing Address - Country:US
Mailing Address - Phone:315-488-7685
Mailing Address - Fax:
Practice Address - Street 1:2105 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1656
Practice Address - Country:US
Practice Address - Phone:315-488-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2009-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009146225700000X
NY002396-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant