Provider Demographics
NPI:1225139389
Name:COMELLA, SANDRA SHAFFER (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:SHAFFER
Last Name:COMELLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7113 DUMBARTON PL
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102
Mailing Address - Country:US
Mailing Address - Phone:412-831-7879
Mailing Address - Fax:
Practice Address - Street 1:1848 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220
Practice Address - Country:US
Practice Address - Phone:412-344-7744
Practice Address - Fax:412-344-5502
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP000325A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC01818851OtherBLUE SHIELD
PAP00269354OtherRR MEDICARE
PAC01818851OtherBLUE SHIELD
PA007423TNAMedicare ID - Type Unspecified