Provider Demographics
NPI:1922980655
Name:ST. NICHOLAS, STEPHANIE EILEEN
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:EILEEN
Last Name:ST. NICHOLAS
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 1:545 SMITHTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-4915
Mailing Address - Country:US
Mailing Address - Phone:631-291-7276
Mailing Address - Fax:
Practice Address - Street 1:545 SMITHTOWN AVE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-4915
Practice Address - Country:US
Practice Address - Phone:631-291-7276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist