Provider Demographics
NPI:1649361825
Name:BEY, STEPHANIE RENEE (PAC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:RENEE
Last Name:BEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:RENEE
Other - Last Name:PURNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:1296 BETHEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9212
Mailing Address - Country:US
Mailing Address - Phone:302-449-2062
Mailing Address - Fax:
Practice Address - Street 1:4745 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 134 MEDICAL ARTS PAVILLION 1
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-738-5300
Practice Address - Fax:302-731-4822
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000470363A00000X
PAMA051892363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA092481ETKMedicare ID - Type Unspecified
Q47653Medicare UPIN