Healthcare Provider Details

I. General information

NPI: 1972422632
Provider Name (Legal Business Name): WAYLON DEAN STOUFFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

364 CHANNING DR
CHAMBERSBURG PA
17201-3201
US

V. Phone/Fax

Practice location:
  • Phone: 302-320-2620
  • Fax:
Mailing address:
  • Phone: 717-446-3893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: