Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 298258 | NY |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 298258 | NY |
NPI | 1053754705 |
---|---|
Provider Name | Stephanie Kyc |
First Address | Stony Brook, NY 11790-0989 |
Second Address | Stony Brook, NY 11794 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2013 |
Last Update Date | 12/11/2019 |