Provider Demographics
NPI:1912507682
Name:STASIK, STEPHANIE CLAIRE (RN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CLAIRE
Last Name:STASIK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PURITAN PATH
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1411
Mailing Address - Country:US
Mailing Address - Phone:336-202-8169
Mailing Address - Fax:
Practice Address - Street 1:7 PURITAN PATH
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1411
Practice Address - Country:US
Practice Address - Phone:336-202-8169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY805164163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse