Individual provider Active NPI

Gabrielle M. Stacy, PA-C

  • Medical Physician Assistant
  • Allentown, PA
National Provider Identifier
1811297823
Registry record updated Oct 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA054708 Issued in PA
Practice address
1255 S Cedar Crest Blvd
Suite 2200
Allentown, PA 18103-6256
Phone
(610) 437-9006
Fax
(610) 437-1942
NPI assigned
Oct 25, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA054708 PA Primary

Addresses

Primary practice location

1255 S Cedar Crest Blvd
Suite 2200
Allentown, PA 18103-6256

Mailing address

1255 S Cedar Crest Blvd
Suite 2200
Allentown, PA 18103-6256
Phone (610) 437-9006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA054708PAMDMedical Physician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1287964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287964800000",
    "number": "1811297823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 S CEDAR CREST BLVD",
            "address_2": "SUITE 2200",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036256",
            "telephone_number": "610-437-9006",
            "fax_number": "610-437-1942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 S CEDAR CREST BLVD",
            "address_2": "SUITE 2200",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036256",
            "telephone_number": "610-437-9006",
            "fax_number": "610-437-1942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACY",
        "first_name": "GABRIELLE",
        "middle_name": "M.",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-25",
        "last_updated": "2010-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA054708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.