Provider Demographics
NPI:1699781120
Name:BRANDT, STACY MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MARIE
Last Name:BRANDT
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 1:1038 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2912
Mailing Address - Country:US
Mailing Address - Phone:304-232-7151
Mailing Address - Fax:304-232-6128
Practice Address - Street 1:1038 MARKET ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2912
Practice Address - Country:US
Practice Address - Phone:304-232-7151
Practice Address - Fax:304-232-6128
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01010363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00112121OtherRAILROAD MEDICARE
WVP00112121OtherRAILROAD MEDICARE
WVPA33561Medicare PIN
WVP00112121OtherRAILROAD MEDICARE