Individual
MRS. STEPHANIE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NEMT
Contact information
Practice address
60 MAIN ST # 61, ESOPUS, NY 12429-9800
(845) 901-9966
Mailing address
PO BOX 61, ESOPUS, NY 12429-0061
(845) 901-9966
Taxonomy
Speciality
Code
Description
License number
State
342000000X
Transportation Network Company
Primary
—
—
Other
Enumeration date
06/17/2022
Last updated
06/17/2022
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