Provider Demographics
NPI:1457668410
Name:MERCER, STEPHANIE A (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:MERCER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:WERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19 W JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3601
Mailing Address - Country:US
Mailing Address - Phone:631-604-4023
Mailing Address - Fax:631-604-4027
Practice Address - Street 1:19 W JERICHO TPKE
Practice Address - Street 2:GOHEALTH URGENT CARE
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3601
Practice Address - Country:US
Practice Address - Phone:631-604-4023
Practice Address - Fax:631-604-4027
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015509363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1095067OtherNCCPA
AZ557306Medicaid
NY04649450Medicaid
NY04649450Medicaid