Provider Demographics
NPI:1699112433
Name:SCHMUCKER, SHELLY LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:SCHMUCKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:LYNN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:300 STATE ST
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1427
Mailing Address - Country:US
Mailing Address - Phone:814-877-6997
Mailing Address - Fax:814-877-6356
Practice Address - Street 1:300 STATE ST
Practice Address - Street 2:SUITE 400A
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1427
Practice Address - Country:US
Practice Address - Phone:814-877-6997
Practice Address - Fax:814-877-6356
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058342363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant