1992015747 NPI number — HEATHER A SHEVCHIK O'BRIEN PA-C

Table of content: HEATHER A SHEVCHIK O'BRIEN PA-C (NPI 1992015747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992015747 NPI number — HEATHER A SHEVCHIK O'BRIEN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEVCHIK O'BRIEN
Provider First Name:
HEATHER
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHEVCHIK
Provider Other First Name:
HEATHER
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992015747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N ACADEMY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17822-4903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-271-6144
Provider Business Mailing Address Fax Number:
570-271-6578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 N LOGAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURNHAM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17009-1850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-242-0196
Provider Business Practice Location Address Fax Number:
717-242-0701
Provider Enumeration Date:
10/14/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  MA054616 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50093217 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".