Provider Demographics
NPI:1790182434
Name:SLASKI, STEPHANIE (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SLASKI
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 LANCASTER AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1378
Mailing Address - Country:US
Mailing Address - Phone:610-989-2224
Mailing Address - Fax:610-947-1220
Practice Address - Street 1:92 LANCASTER AVE STE 120
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1378
Practice Address - Country:US
Practice Address - Phone:610-989-2224
Practice Address - Fax:610-947-1220
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057329363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000911074OtherANTHEM BLUE CROSS & BLUE SHIELD
OH000000911074OtherANTHEM BLUE CROSS & BLUE SHIELD