Individual provider · Type 1 NPI

Stacy Marie Russo, RN

Registered Nurse · Port Jefferson Station, NY

NPI number 1770041774 Active

Practice location

1 Kool Pl
Port Jefferson Station, NY 11776-3312

Specialties and licenses

TaxonomyCodeLicense
Registered Nurse Primary 163W00000X515069 (NY)

Registered Nurse: (1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.'s assist patient…

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About NPI 1770041774

Stacy Marie Russo, RN's National Provider Identifier is 1770041774, issued on Mar 8, 2019. The primary taxonomy on file is Registered Nurse (163W00000X), and the practice location is in Port Jefferson Station, NY. The record was last updated on Sep 29, 2026.