Individual
STACIE TITTAMIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
736 IRVING AVE, SYRACUSE, NY 13210-1602
(315) 440-7111
Mailing address
24 MONHEGON AVE, ROCKAWAY, NJ 07866-1808
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR13744500
NJ
367500000X
Certified Registered Nurse Anesthetist
26NJ01041100
NJ
367500000X
Certified Registered Nurse Anesthetist
Primary
740498
NY
Other
Enumeration date
06/04/2020
Last updated
09/15/2025
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