Provider Demographics
NPI:1528068905
Name:STEFANIAK, ANDREW M (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:STEFANIAK
Suffix:
Gender:M
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 1:490 E NORTH AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4740
Mailing Address - Country:US
Mailing Address - Phone:412-359-5822
Mailing Address - Fax:412-359-6620
Practice Address - Street 1:490 E NORTH AVE STE 307
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4740
Practice Address - Country:US
Practice Address - Phone:412-321-0680
Practice Address - Fax:412-359-6620
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003051L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA092049NJ5Medicare PIN
PAS96572Medicare UPIN