Provider Demographics
NPI:1215465422
Name:DEFELICE, DANA ALICE I (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:ALICE
Last Name:DEFELICE
Suffix:I
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOLMES PL
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-4538
Mailing Address - Country:US
Mailing Address - Phone:724-689-9422
Mailing Address - Fax:
Practice Address - Street 1:6301 FORBES AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1725
Practice Address - Country:US
Practice Address - Phone:412-422-5970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058924363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty