Provider Demographics
NPI:1720330285
Name:SHARPE, STACY ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANN
Last Name:SHARPE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14610 RAVEN CT
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4956
Mailing Address - Country:US
Mailing Address - Phone:586-322-5400
Mailing Address - Fax:
Practice Address - Street 1:6450 FARMINGTON RD STE 115
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4456
Practice Address - Country:US
Practice Address - Phone:734-331-6037
Practice Address - Fax:734-331-6260
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006512363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical