Provider Demographics
NPI:1821311440
Name:DICLEMENTE, STEPHANIE SHULL (PA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SHULL
Last Name:DICLEMENTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 SPROUL RD
Mailing Address - Street 2:STE 25
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3508
Mailing Address - Country:US
Mailing Address - Phone:610-353-6400
Mailing Address - Fax:610-356-1204
Practice Address - Street 1:1999 SPROUL RD
Practice Address - Street 2:STE 25
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3508
Practice Address - Country:US
Practice Address - Phone:610-353-6400
Practice Address - Fax:610-356-1204
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054104363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical