Healthcare Provider Details

I. General information

NPI: 1649361825
Provider Name (Legal Business Name): STEPHANIE RENEE BEY PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE RENEE PURNELL PAC

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD SUITE 134 MEDICAL ARTS PAVILLION 1
NEWARK DE
19713-2067
US

IV. Provider business mailing address

1296 BETHEL CHURCH RD
MIDDLETOWN DE
19709-9212
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-5300
  • Fax: 302-731-4822
Mailing address:
  • Phone: 302-449-2062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC50000470
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA051892
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: