Provider Demographics
NPI:1669489233
Name:STAHL, STEPHANIE BETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:BETH
Last Name:STAHL
Suffix:
Gender:F
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 1:111 COLCHESTER AVE, 4TH FLOOR ACC MAIN PAVILION
Mailing Address - Street 2:FLETCHER ALLEN HEALTH CARE: WOMEN'S HEALTH CARE SERVICE
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-847-5110
Mailing Address - Fax:802-847-0496
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:FAHC, MAIN PAVILLION-4TH FLOOR ACC
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0030719363A00000X
NY015404-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000214Medicaid
VT9000214Medicaid
VTQ20608Medicare UPIN