1932752094 NPI number — DR. CHRISTINE GONZALES SHIFFLET OD

Table of content: DR. CHRISTINE GONZALES SHIFFLET OD (NPI 1932752094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932752094 NPI number — DR. CHRISTINE GONZALES SHIFFLET OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALES SHIFFLET
Provider First Name:
CHRISTINE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALES
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932752094
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 ENTERPRISE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENWOOD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17810-9260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-538-6002
Provider Business Mailing Address Fax Number:
570-538-1969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 RIVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17701-3722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-995-3937
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2019

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: 152W00000X , with the licence number:  OEG003555 , 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)





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