Provider Demographics
NPI:1528495512
Name:MURACA, STEPHANIE LEE (RN, BSN, MS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:MURACA
Suffix:
Gender:F
Credentials:RN, BSN, MS
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LEE
Other - Last Name:DUDAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:375 W ONONDAGA ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1888
Mailing Address - Country:US
Mailing Address - Phone:315-478-2030
Mailing Address - Fax:315-478-2250
Practice Address - Street 1:375 W ONONDAGA ST
Practice Address - Street 2:SUITE 10
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1888
Practice Address - Country:US
Practice Address - Phone:315-478-2030
Practice Address - Fax:315-478-2250
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY375148-1163W00000X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult