Provider Demographics
NPI:1881429314
Name:BUFFALOBOY, STEPHANIE KAY
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:BUFFALOBOY
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 1:8933 PATTERSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26710-5105
Mailing Address - Country:US
Mailing Address - Phone:304-932-5139
Mailing Address - Fax:
Practice Address - Street 1:8933 PATTERSON CREEK RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WV
Practice Address - Zip Code:26710-5105
Practice Address - Country:US
Practice Address - Phone:304-932-5139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist