Provider Demographics
NPI:1528218765
Name:STASIK, DANIEL MATTHEW (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MATTHEW
Last Name:STASIK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-3052
Mailing Address - Country:US
Mailing Address - Phone:775-867-7740
Mailing Address - Fax:
Practice Address - Street 1:801 E WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3052
Practice Address - Country:US
Practice Address - Phone:775-867-7740
Practice Address - Fax:775-423-4219
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
12196146OtherCAQH
NVCW172VMedicare PIN