Provider Demographics
NPI:1679831960
Name:FERELLO, STEPHANIE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:FERELLO
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 1:87 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5044
Mailing Address - Country:US
Mailing Address - Phone:978-208-4756
Mailing Address - Fax:978-685-5950
Practice Address - Street 1:87 JACKSON ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5044
Practice Address - Country:US
Practice Address - Phone:978-208-4756
Practice Address - Fax:978-685-5950
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4301363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical