Provider Demographics
NPI:1154848943
Name:CAJA, STEPHANIE ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:CAJA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:BLYSTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4136 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-8691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 INGALLS DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:708-915-5290
Practice Address - Fax:708-915-4925
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085006217363A00000X
PAMA059825363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant