Provider Demographics
NPI:1053657668
Name:MAHON, CHELSEY A (PA)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEY
Middle Name:A
Last Name:MAHON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:CHELSEY
Other - Middle Name:A
Other - Last Name:SPADT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:175 CROSS KEYS RD
Mailing Address - Street 2:BUILDING 300A
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9263
Mailing Address - Country:US
Mailing Address - Phone:856-767-0077
Mailing Address - Fax:856-767-6102
Practice Address - Street 1:175 CROSS KEYS RD
Practice Address - Street 2:BUILDING 300A
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9263
Practice Address - Country:US
Practice Address - Phone:856-767-0077
Practice Address - Fax:856-767-6102
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00299600363A00000X
PAMA055855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant