Provider Demographics
NPI:1083469977
Name:ROBUSTELLI, STACY BRIANNE (PA-C)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:BRIANNE
Last Name:ROBUSTELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3314
Mailing Address - Country:US
Mailing Address - Phone:215-802-4375
Mailing Address - Fax:
Practice Address - Street 1:1200 OLD YORK ROAD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001
Practice Address - Country:US
Practice Address - Phone:215-802-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant