Provider Demographics
NPI:1336459924
Name:AMORTEGUI, CHELCIE IRENE (PA)
Entity Type:Individual
Prefix:
First Name:CHELCIE
Middle Name:IRENE
Last Name:AMORTEGUI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHELCIE
Other - Middle Name:IRENE
Other - Last Name:YEZIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1469 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-2256
Mailing Address - Country:US
Mailing Address - Phone:610-419-7800
Mailing Address - Fax:610-419-7810
Practice Address - Street 1:1469 8TH AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-2256
Practice Address - Country:US
Practice Address - Phone:610-419-7800
Practice Address - Fax:610-419-7810
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054677363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA054677OtherLICENSE NUMBER