Provider Demographics
NPI:1730782533
Name:HO, STEPHANIE K
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:HO
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 1:4373 UNION ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3191
Mailing Address - Country:US
Mailing Address - Phone:718-886-2278
Mailing Address - Fax:718-886-3995
Practice Address - Street 1:4373 UNION ST STE 1B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3191
Practice Address - Country:US
Practice Address - Phone:718-886-2278
Practice Address - Fax:718-886-3995
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
027170363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program