Provider Demographics
NPI:1417211004
Name:KILLEEN, STEPHANIE R (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:R
Last Name:KILLEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:RHIANNON
Other - Last Name:WILKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:372 POST AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2201
Mailing Address - Country:US
Mailing Address - Phone:516-333-1444
Mailing Address - Fax:516-333-2725
Practice Address - Street 1:372 POST AVE STE 106
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2201
Practice Address - Country:US
Practice Address - Phone:516-333-1444
Practice Address - Fax:516-333-2725
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301116986207V00000X
CODR.0060045207V00000X
NY284804207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology