Provider Demographics
NPI:1316214679
Name:SOSSONG, STEPHANIE DELORES (PAC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DELORES
Last Name:SOSSONG
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DELORES
Other - Last Name:DUDZINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1307 FEDERAL ST
Mailing Address - Street 2:SUITE B100
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4769
Mailing Address - Country:US
Mailing Address - Phone:412-359-8900
Mailing Address - Fax:412-359-8977
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:SUITE B100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-359-8900
Practice Address - Fax:412-359-8977
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055666363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103187069Medicaid
PA103187069Medicaid