Healthcare Provider Details

I. General information

NPI: 1659025336
Provider Name (Legal Business Name): EMILY FAZIO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY SIPPEY PA-C

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 GALLERY DR
MC MURRAY PA
15317-2690
US

IV. Provider business mailing address

138 GALLERY DR
MC MURRAY PA
15317-2690
US

V. Phone/Fax

Practice location:
  • Phone: 724-260-7300
  • Fax:
Mailing address:
  • Phone: 724-260-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA063217
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier15548303
Identifier TypeOTHER
Identifier State
Identifier IssuerCAQH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: