Provider Demographics
NPI:1538595129
Name:TAKASH, STEPHANIE L (MED)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:L
Last Name:TAKASH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:LYNNE
Other - Last Name:TAKASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:2114 YORK RD W
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14486-9719
Mailing Address - Country:US
Mailing Address - Phone:229-886-2903
Mailing Address - Fax:
Practice Address - Street 1:5871 GROVELAND STATION RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-9767
Practice Address - Country:US
Practice Address - Phone:585-658-4023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist