Individual
STEPHANIE CHARIS MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
301 SMITHTOWN BLVD, NESCONSET, NY 11767-2080
(631) 737-1492
(631) 588-0016
Mailing address
35 POND PATH, LAKE GROVE, NY 11755-1828
(631) 672-2953
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
753451-1
NY
Other
Enumeration date
03/15/2019
Last updated
03/15/2019
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