Provider Demographics
NPI:1275061384
Name:WEINSTEIN, ANEESA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANEESA
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANEESA
Other - Middle Name:
Other - Last Name:MANDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 SIR THOMAS CT FL 2
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4839
Mailing Address - Country:US
Mailing Address - Phone:717-657-3030
Mailing Address - Fax:717-671-0991
Practice Address - Street 1:805 SIR THOMAS CT FL 2
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4839
Practice Address - Country:US
Practice Address - Phone:717-657-3030
Practice Address - Fax:717-671-0991
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059169363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103338440Medicaid