Stephanie Mederos, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

02746301 Issued in NY

Practice address

53 Chester St
Lake Grove, NY 11755-3047

Phone

(631) 455-2971

NPI assigned

Sep 13, 2021

Last updated

Sep 13, 2021By 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

Other names 1

• Stephanie Taveras Former name

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": "1631491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1710656681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 CHESTER ST",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117553047",
            "telephone_number": "631-455-2971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 CHESTER ST",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117553047",
            "telephone_number": "631-455-2971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDEROS",
        "first_name": "STEPHANIE",
        "credential": "RDH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-13",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "NY",
            "license": "02746301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "TAVERAS",
            "credential": "RDH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joseph B. McCarthy, LCSW-R
• Michele McCauley
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• Maureen McKeon-Simone, RD
• Colleen McMahon
• Medical Arts Radiological Group, P.C.
• Medical Doctor Visit Me PLLC
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• Allison Meiselbach, MSW
• Matthew Merensky, PA-C

• Dental Hygienist in Lake Grove, NY
• Providers in Lake Grove, NY by specialty
• Dental Hygienist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; 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.