Rachael Mary Stacom, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

304736 Issued in NY

Practice address

1770 Grand Concourse
Suite 2G
Bronx, NY 10457-5524

Phone

(718) 393-7617

NPI assigned

Feb 21, 2008

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": "1203552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203552000000",
    "number": "1184893497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 E 83RD ST",
            "address_2": "APT 1",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100280813",
            "telephone_number": "212-744-6731",
            "fax_number": "212-995-5016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 GRAND CONCOURSE",
            "address_2": "SUITE 2G",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104575524",
            "telephone_number": "718-393-7617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACOM",
        "first_name": "RACHAEL",
        "middle_name": "MARY",
        "credential": "ANP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-02-21",
        "last_updated": "2008-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "304736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Santana St.Cloud, LCSW
• Irene St.Firmin, LPN
• Riccardo David St.Hill, PTA
• St.Mary'S Hospital for Children
• St.Thomas Physical Therapy,PC.
• Zehavya Tzipora Stadlan
• Christine Staeger-Hirsch, MD
• Takiyah Tanner Stafford-Robinson, M.S.ED
• Precious Stafford
• Ursula Ma Stafford

• Adult Health Nurse Practitioner in Bronx, NY
• Providers in Bronx, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2008; 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.