Provider Demographics
NPI:1851792972
Name:STAPLETON, MEREDITH SPENCER (PA-C)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:SPENCER
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:SPENCER
Other - Last Name:BEARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:159 E 74TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3235
Mailing Address - Country:US
Mailing Address - Phone:212-737-3301
Mailing Address - Fax:212-734-0407
Practice Address - Street 1:159 E 74TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3235
Practice Address - Country:US
Practice Address - Phone:212-737-3301
Practice Address - Fax:212-734-0407
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant