Stacy T Sullenberger, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

APRN.CNP.14148 Issued in OH

Practice address

915 Michigan St
Sidney, OH 45365-2401

Phone

(937) 498-4488

NPI assigned

Jan 4, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dayton Children'S Hospital

  • Child & Adolescent Psychiatry Physician
  • Dayton, OH
  • NPI 1952480030
  Medicare reassignment
• Dayton Children'S Specialty Physicians, Inc.

  • Pediatrics Physician
  • Dayton, OH
  • NPI 1225192610
  Medicare reassignment
• Dayton Children'S Hospital

  • Social Worker
  • Dayton, OH
  • NPI 1548045503
  NPD
• Child and Adolescent Specialty Care of Dayton Inc.

  • Pediatric Adolescent Medicine Physician
  • Tipp City, OH
  • NPI 1881794113
  NPD (past)
• Shelby County Memorial Hospital Association Inc.

  • General Acute Care Hospital
  • Sidney, OH
  • NPI 1639174204
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780012800000",
    "number": "1023355484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933421",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930039",
            "telephone_number": "937-641-5072",
            "fax_number": "937-641-6129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 MICHIGAN ST",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453652401",
            "telephone_number": "937-498-4488"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "792 Northwoods Blvd",
            "address_purpose": "LOCATION",
            "city": "Vandalia",
            "state": "OH",
            "postal_code": "453779462",
            "country_code": "US",
            "telephone_number": "937-641-4236",
            "fax_number": "937-641-4237",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4475 Far Hills Ave",
            "address_purpose": "LOCATION",
            "city": "Kettering",
            "state": "OH",
            "postal_code": "454292405",
            "country_code": "US",
            "telephone_number": "937-641-3141",
            "fax_number": "937-641-3190",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3301 Dayton Xenia Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Beavercreek",
            "state": "OH",
            "postal_code": "454322759",
            "country_code": "US",
            "telephone_number": "937-641-5098",
            "fax_number": "937-912-9395",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "662 N Main St",
            "address_purpose": "LOCATION",
            "city": "Springboro",
            "state": "OH",
            "postal_code": "450669553",
            "country_code": "US",
            "telephone_number": "937-641-5066",
            "fax_number": "937-550-9797",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8501 Old Troy Pike",
            "address_purpose": "LOCATION",
            "city": "Huber Heights",
            "state": "OH",
            "postal_code": "454241054",
            "country_code": "US",
            "telephone_number": "937-641-4360",
            "fax_number": "937-949-3791",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7787 Cox Ln",
            "address_purpose": "LOCATION",
            "city": "West Chester",
            "state": "OH",
            "postal_code": "450696549",
            "country_code": "US",
            "telephone_number": "937-641-5757",
            "fax_number": "513-847-1192",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1711 Germantown Pike",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "45417",
            "country_code": "US",
            "telephone_number": "937-641-3142",
            "fax_number": "937-641-4172",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3333 W Tech Rd",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453420955",
            "country_code": "US",
            "telephone_number": "937-641-5725",
            "fax_number": "937-350-3050",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Childrens Plz",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454041815",
            "country_code": "US",
            "telephone_number": "937-641-4000",
            "fax_number": "937-641-4500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLENBERGER",
        "first_name": "STACY",
        "middle_name": "T",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-04",
        "last_updated": "2026-05-29",
        "certification_date": "2026-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OH",
            "license": "APRN.CNP.14148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0330291",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Strunk
• Taylor Marie Stumph
• Nicole Angelique Stutz, RBT
• Cassandra Subler
• Bruce A Suchland, CNP
• Kaitlin R Sutter, ATC,AT
• Penny Darlene Swallow
• Kenneth J Swank
• Nadia Szymanski, PHARMD
• Tammy Bridenbaugh

• Pediatric Nurse Practitioner in Sidney, OH
• Providers in Sidney, OH by specialty
• Pediatric Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.