Provider Demographics
NPI:1164745683
Name:SQUILLANTE, DAWN M (PA-C)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:SQUILLANTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:SCHLEMBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE STE 370
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-642-3005
Mailing Address - Fax:610-642-3057
Practice Address - Street 1:100 E LANCASTER AVE STE 370
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-642-3005
Practice Address - Fax:610-642-3057
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003050L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical