Provider Demographics
NPI:1417727066
Name:GRAY, STASIA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:STASIA
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:
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 1:13200 FALLS OF NEUSE RD STE 113
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8269
Mailing Address - Country:US
Mailing Address - Phone:919-554-6754
Mailing Address - Fax:
Practice Address - Street 1:13200 FALLS OF NEUSE RD STE 113
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8269
Practice Address - Country:US
Practice Address - Phone:919-554-6754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-15068OtherNC STATE LICENSE