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General NPI Number Information
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NPI Number | 1558486985
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Entity Type | Individual
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Provider Name | STEPHANIE M PENA PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 67 UNION STREET SUITE 308
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City | NATICK
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State | MA
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Zip | 01760
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Country | US
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Telephone | 508-655-4422
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Fax | 508-655-9191
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Provider Business Mailing Address
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Address Line | 67 UNION STREET SUITE 308
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City | NATICK
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State | MA
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Zip | 01760
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Country | US
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Telephone | 508-655-4422
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Fax | 508-655-9191
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | AP2050
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License Number State | MA
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