Provider Demographics
NPI:1851786172
Name:DIMASI, STEPHANIE V (AGNP-BC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:V
Last Name:DIMASI
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 LINCOLN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3776
Mailing Address - Country:US
Mailing Address - Phone:781-941-2241
Mailing Address - Fax:
Practice Address - Street 1:480 LINCOLN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3776
Practice Address - Country:US
Practice Address - Phone:781-941-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2287619163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse