Provider Demographics
NPI:1588996193
Name:MACEIRAS, STEPHANIE (NP, LAC, RN)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:MACEIRAS
Suffix:
Gender:F
Credentials:NP, LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 HUNTINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3916
Mailing Address - Country:US
Mailing Address - Phone:347-223-2592
Mailing Address - Fax:
Practice Address - Street 1:167 HUNTINGTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3916
Practice Address - Country:US
Practice Address - Phone:347-223-2592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-06
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004179-1171100000X
NY689700163W00000X
NYF308116363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse