Healthcare Provider Details

I. General information

NPI: 1295182491
Provider Name (Legal Business Name): EMILY STAYROOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY TERCEK

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 S WASHINGTON AVE
GREENSBURG PA
15601-2768
US

IV. Provider business mailing address

44 S WASHINGTON AVE
GREENSBURG PA
15601-2768
US

V. Phone/Fax

Practice location:
  • Phone: 724-261-5556
  • Fax: 724-689-0544
Mailing address:
  • Phone: 724-261-5556
  • Fax: 724-689-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA058230
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: