Provider Demographics
NPI:1083371140
Name:SCHECHTERLY, ALEX MITCHELL (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:MITCHELL
Last Name:SCHECHTERLY
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 1:114 PARK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHICKSHINNY
Mailing Address - State:PA
Mailing Address - Zip Code:18655-4324
Mailing Address - Country:US
Mailing Address - Phone:570-336-3922
Mailing Address - Fax:
Practice Address - Street 1:1045 5TH ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-4204
Practice Address - Country:US
Practice Address - Phone:209-827-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA60397363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant