Healthcare Provider Details

I. General information

NPI: 1487431185
Provider Name (Legal Business Name): EMILY PRENCIPE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

1805 S BROAD ST
PHILADELPHIA PA
19148-2160
US

V. Phone/Fax

Practice location:
  • Phone: 610-645-9093
  • Fax:
Mailing address:
  • Phone: 814-335-9967
  • 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: