Provider Demographics
NPI:1235178278
Name:RYAN, STACY R (PA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:R
Last Name:RYAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-0907
Mailing Address - Country:US
Mailing Address - Phone:215-257-3697
Mailing Address - Fax:215-453-3410
Practice Address - Street 1:915 LAWN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1551
Practice Address - Country:US
Practice Address - Phone:215-257-3697
Practice Address - Fax:215-453-3410
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-12-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA051060363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101447Medicare PIN