Individual
STACY ELLEN SHIMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1600 ROCKLAND RD, WILMINGTON, DE 19803-3607
(302) 651-4200
Mailing address
PO BOX 191, ROCKLAND, DE 19732-0191
(302) 651-4200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002208
CT
363A00000X
Physician Assistant
Primary
MA054808
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA054808
PENNSYLVANIA MEDICAL STATE LICENSE
PA
Enumeration date
12/01/2008
Last updated
01/20/2020
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