| Doctor Name: | MS. STACY LYNNE HEUSCHNEIDER |
| NPI Number: | 1063788578 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | F305532 |
| Business Practice Address: | 48 Locust Drive Nesconset, NY - 11767 |
| Business Phone Number: | 6317245692 |
| Business Fax Number: | |
| Mailing Address: | 48 Locust Drive, NESCONSET |
| State: | NY |
| Postal Code: | 11767 |
| Phone Number: | 6317245692 |
| Fax Number: | |
| NPI Enumeration Date: | 03/29/2012 |
| NPI Last Update Date: | 03/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | F305532 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |