Provider Demographics
NPI:1144084815
Name:BAKER, STEPHANIE BAVOLAR (FNP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BAVOLAR
Last Name:BAKER
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:1345 AVENUE OF THE AMERICAS FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10105-0018
Mailing Address - Country:US
Mailing Address - Phone:908-588-3635
Mailing Address - Fax:908-934-9350
Practice Address - Street 1:210 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2901
Practice Address - Country:US
Practice Address - Phone:914-607-6250
Practice Address - Fax:914-607-6252
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY353607363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner