Basic Information
| Provider Information | |||||||||
| NPI: | 1992141212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAWHIRT | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 BURLEIGH DR | ||||||||
| Address2: | |||||||||
| City: | HOLBROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117413005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317903653 | ||||||||
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| Practice Location | |||||||||
| Address1: | 222 STATION PLZ N | ||||||||
| Address2: | SUITE 509 | ||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115013800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166632381 | ||||||||
| FaxNumber: | 5166638796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2013 | ||||||||
| LastUpdateDate: | 02/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 287891 | NY | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.