| Doctor Name: | STACY T SULLENBERGER |
| NPI Number: | 1023355484 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | 14148 NP |
| Business Practice Address: | 1483 W Main St Tipp City, OH - 453712803 |
| Business Phone Number: | 9376678067 |
| Business Fax Number: | |
| Mailing Address: | 1483 W Main St, TIPP CITY |
| State: | OH |
| Postal Code: | 453712803 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/04/2013 |
| NPI Last Update Date: | 01/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 14148 NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |