=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154587418
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE SARISKY-MELOY DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2008
-----------------------------------------------------
Last Update Date | 08/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4545 E SHEA BLVD STE. 175
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85028-3074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-314-6780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 ERIN DR
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17821-8477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-275-9554
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS008146L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------