Provider Demographics
NPI:1134302896
Name:OCHALEK, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:OCHALEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21159 PAINT BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:SHIPPENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16254-4023
Mailing Address - Country:US
Mailing Address - Phone:814-297-5090
Mailing Address - Fax:
Practice Address - Street 1:21159 PAINT BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SHIPPENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16254-4023
Practice Address - Country:US
Practice Address - Phone:814-297-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA007119363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA460611ECTOtherMEDICARE