Healthcare Provider Details

I. General information

NPI: 1417727066
Provider Name (Legal Business Name): STASIA MARIE GRAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 COLONADES WAY STE 205
CARY NC
27518-1603
US

IV. Provider business mailing address

302 COLONADES WAY STE 205
CARY NC
27518-1603
US

V. Phone/Fax

Practice location:
  • Phone: 919-851-8989
  • Fax:
Mailing address:
  • Phone: 919-851-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-15068
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: