Provider Demographics
NPI:1396992251
Name:SHELLENBERGER, KRISTY (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:SHELLENBERGER
Suffix:
Gender:F
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 1:3380 MEMPHIS ST
Mailing Address - Street 2:MEMPHIS STREET PEDIATRICS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4510
Mailing Address - Country:US
Mailing Address - Phone:215-426-5566
Mailing Address - Fax:215-739-7304
Practice Address - Street 1:3380 MEMPHIS ST
Practice Address - Street 2:MEMPHIS STREET PEDIATRICS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4510
Practice Address - Country:US
Practice Address - Phone:215-426-5566
Practice Address - Fax:215-739-7304
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002088363AM0700X
PAMA051755363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical