Provider Demographics
NPI:1508048430
Name:PANASCI, STACEY (PA-C)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:PANASCI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:300 CAREW ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2485
Mailing Address - Country:US
Mailing Address - Phone:413-781-5050
Mailing Address - Fax:413-781-2510
Practice Address - Street 1:300 CAREW ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2485
Practice Address - Country:US
Practice Address - Phone:413-781-5050
Practice Address - Fax:413-781-2510
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant