1295872380 NPI number — MRS. SHELLEY ANN SAVOROSKI MPAS, PA-C

Table of content: MRS. SHELLEY ANN SAVOROSKI MPAS, PA-C (NPI 1295872380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295872380 NPI number — MRS. SHELLEY ANN SAVOROSKI MPAS, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAVOROSKI
Provider First Name:
SHELLEY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPAS, 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:
DUS
Provider Other First Name:
SHELLEY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPAS,PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295872380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8150 PERRY HWY STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237-5200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-364-2664
Provider Business Mailing Address Fax Number:
412-369-9566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 PERRY HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15237-2160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-364-4402
Provider Business Practice Location Address Fax Number:
412-364-2850
Provider Enumeration Date:
01/30/2007

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: 363AS0400X , with the licence number:  MA052627 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: MA052627 , 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: 103203411-0009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103203411-0010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".