Provider Demographics
NPI:1285726497
Name:DISTEFANO, PAMELA ANN (RPA-C)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:DISTEFANO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-1415
Mailing Address - Country:US
Mailing Address - Phone:845-246-3000
Mailing Address - Fax:845-246-7622
Practice Address - Street 1:16 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-1415
Practice Address - Country:US
Practice Address - Phone:845-246-3000
Practice Address - Fax:845-246-7622
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003834-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP31912Medicare UPIN