Provider Demographics
NPI:1366869810
Name:SHANK, DEANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:SHANK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:BUHAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1754
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-1754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2597 SCHOENERSVILLE RD
Practice Address - Street 2:STE 201
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7325
Practice Address - Country:US
Practice Address - Phone:610-867-4545
Practice Address - Fax:610-867-0843
Is Sole Proprietor?:No
Enumeration Date:2014-03-22
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056793363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical