Individual provider Active NPI

Stacy St Phard

  • Licensed Practical Nurse
  • Valley Stream, NY
National Provider Identifier
1013707355
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
34222-01 Issued in NY
Practice address
20 Kalmia LN
Valley Stream, NY 11581-2317
Phone
(917) 982-8201
NPI assigned
May 9, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 34222-01 NY Primary

Addresses

Primary practice location

20 Kalmia LN
Valley Stream, NY 11581-2317

Mailing address

20 Kalmia LN
Valley Stream, NY 11581-2317
Phone (917) 982-8201

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
34222-01NYMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746748800000",
    "number": "1013707355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 KALMIA LN",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115812317",
            "telephone_number": "917-982-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 KALMIA LN",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115812317",
            "telephone_number": "917-982-8201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST PHARD",
        "first_name": "STACY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-09",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "34222-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Stream, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.