Provider Demographics
NPI:1891741492
Name:OSTAPKO, STACY JAYNE (MD, FAAP)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:JAYNE
Last Name:OSTAPKO
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13557 STEELECROFT PKWY STE 2200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7559
Practice Address - Country:US
Practice Address - Phone:704-316-1080
Practice Address - Fax:704-316-1085
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-01868208000000X
VA0101235067208000000X
NC208000000X208000000X
GA064877208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541778786OtherCOMMERCIAL HMO/PPO
VA541778786OtherCOMMERCIAL
VA7533472OtherAETNA
VA177375OtherANTHEM BCBS
VA010168783Medicaid
VA5417787860000EOtherCIGNA
VA94335OtherSENTARA/OPTIMA
VA8134063OtherALLIANCE/MAMSI/MDIPA/OP C
VA541778786OtherCOMMERCIAL HMO/PPO