Kimberly Stavola, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

351003 Issued in NY

Practice address

33 Malba Dr
Shirley, NY 11967-3029

Phone

(631) 413-2337

NPI assigned

Aug 26, 2024

Last updated

Aug 26, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1724630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1043043938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 MALBA DR",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119673029",
            "telephone_number": "631-413-2337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 MALBA DR",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119673029",
            "telephone_number": "631-413-2337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAVOLA",
        "first_name": "KIMBERLY",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-26",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "351003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Solak, LCSW
• Jason Soldt, RN
• David Soto, LIC.AC.
• Edward Soto, LP-MHC
• Gayathri Sridhar, R.PH
• Gary M Stein, DC
• Steven Kolb
• Krystal Steward, LIFE COACH, MA-HSC
• Kylie Maureen Stewart, RN
• Stop & Shop Supermarket Company LLC

• Licensed Practical Nurse in Shirley, NY
• Providers in Shirley, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.