Provider Demographics
NPI:1215990056
Name:WALESKI, WASIL WILLIAM (PA-C)
Entity type:Individual
Prefix:
First Name:WASIL
Middle Name:WILLIAM
Last Name:WALESKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2538
Mailing Address - Country:US
Mailing Address - Phone:724-520-8060
Mailing Address - Fax:724-522-4002
Practice Address - Street 1:540 SOUTH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2774
Practice Address - Country:US
Practice Address - Phone:724-537-0885
Practice Address - Fax:724-532-1931
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002800L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS75709Medicare UPIN
PA465168Medicare PIN