Individual
MRS. MIRA F. STACO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.P. A.N.P.
Contact information
Practice address
819 UNIVERSITY ST, VALLEY STREAM, NY 11581-3517
(516) 569-0887
(516) 569-0887
Mailing address
819 UNIVERSITY ST, VALLEY STREAM, NY 11581-3517
(516) 569-0887
(516) 569-0887
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
F306665
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
401229
NY
Other
Enumeration date
10/08/2009
Last updated
11/14/2013
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