Provider Demographics
NPI:1194723593
Name:DELANEY, STEFANIE LYNNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:LYNNE
Last Name:DELANEY
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 1:955 MAIN ST
Mailing Address - Street 2:SUITE G6
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1961
Mailing Address - Country:US
Mailing Address - Phone:781-729-4878
Mailing Address - Fax:781-729-5989
Practice Address - Street 1:955 MAIN ST
Practice Address - Street 2:SUITE G6
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1961
Practice Address - Country:US
Practice Address - Phone:781-729-4878
Practice Address - Fax:781-729-5989
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1479363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADA-AP2572Medicare ID - Type Unspecified
MAQ61119Medicare UPIN