Provider Demographics
NPI:1205475027
Name:STAEBELL, JENNY
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:STAEBELL
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 1:20 WEBBER AVE
Mailing Address - Street 2:
Mailing Address - City:OAKFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14125-1232
Mailing Address - Country:US
Mailing Address - Phone:585-590-6626
Mailing Address - Fax:
Practice Address - Street 1:20 WEBBER AVE
Practice Address - Street 2:
Practice Address - City:OAKFIELD
Practice Address - State:NY
Practice Address - Zip Code:14125-1232
Practice Address - Country:US
Practice Address - Phone:585-590-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-315307174N00000X
NYALPP-310480174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN