Provider Demographics
NPI:1205617354
Name:FISSELLA, STEPHANIE SUNSHINE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUNSHINE
Last Name:FISSELLA
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 1:212 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:DONEGAL
Mailing Address - State:PA
Mailing Address - Zip Code:15628-9704
Mailing Address - Country:US
Mailing Address - Phone:724-252-4458
Mailing Address - Fax:
Practice Address - Street 1:212 SNYDER RD
Practice Address - Street 2:
Practice Address - City:DONEGAL
Practice Address - State:PA
Practice Address - Zip Code:15628-9704
Practice Address - Country:US
Practice Address - Phone:724-252-4458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily