Provider Demographics
NPI:1730796335
Name:BELLANDE, STEPHANIE (NURSE)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BELLANDE
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 BIRNEY AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-3131
Mailing Address - Country:US
Mailing Address - Phone:570-500-9778
Mailing Address - Fax:
Practice Address - Street 1:2919 BIRNEY AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-3131
Practice Address - Country:US
Practice Address - Phone:570-500-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339542-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse