Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 061136 | NY |
NPI | 1144830100 |
---|---|
Provider Name | Dr. Stephanie Marie Sfiroudis |
First Address | Flushing, NY 11358 |
Second Address | Williston Park, NY 11596-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2020 |
Last Update Date | 21/12/2021 |