Staci Brunell, DMD
Individual provider Active NPI Pediatric Dentistry · Yorktown Heights, NY
NPI 1306366083 · NPPES record last updated Sep 11, 2020
Key facts
- NPI
- 1306366083
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- 059881 (NY)
- Practice address
- 1974 Maple Hill St # a
Yorktown Heights, NY 10598-4190 - Phone
- (914) 245-1670
- NPI assigned
- Jun 22, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 059881 | NY | MD | Pharmacotherapy Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 059881 | NY | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Dentistry | 1223P0221X | 059881 | NY | Yes |
Addresses
Primary practice location
1974 Maple Hill St # a
Yorktown Heights, NY 10598-4190
Mailing address
1974 Maple Hill St # a
Yorktown Heights, NY 10598-4190
Phone (914) 245-1670
Other practice location 1
4422 Third Ave
Department of Dentistry
Bronx, NY 10457
Phone (718) 960-9000
Other providers in Yorktown Heights, NY
- Heidi Brooks
- Joy Brown-Thomas
- Dana Nicole Brown
- Donna Allison Brown
- Matthew James Brown
- Alexandra Bucci
- Elizabeth Ann Burk
- John Joseph Burke Jr.
- David Joseph Byrnes
- Ashley Calajoe
All providers in Yorktown Heights, NY · Pediatric Dentistry in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.