Provider Demographics
NPI:1346799434
Name:DAVIDUK, STEPHANIE MARIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:DAVIDUK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:MEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:915 OLD FERN HILL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-3431
Mailing Address - Country:US
Mailing Address - Phone:610-692-4270
Mailing Address - Fax:610-692-2566
Practice Address - Street 1:915 OLD FERN HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-3431
Practice Address - Country:US
Practice Address - Phone:610-692-4270
Practice Address - Fax:610-692-2566
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058587363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50145502OtherCAPITAL BLUE CROSS
PA50145502OtherCAPITAL BLUE CROSS