Provider Demographics
NPI:1538133871
Name:SHEBA, STACI MAZUREK (DO)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:MAZUREK
Last Name:SHEBA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CHERRY TREE LN
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8947
Mailing Address - Country:US
Mailing Address - Phone:724-438-4364
Mailing Address - Fax:724-438-4720
Practice Address - Street 1:650 CHERRY TREE LN
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8947
Practice Address - Country:US
Practice Address - Phone:724-438-4364
Practice Address - Fax:724-438-4720
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012923207Q00000X, 207Q00000X
PA05012923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017090930005Medicaid
1894429OtherHIGHMARK
PAI50694Medicare UPIN
105934Medicare PIN