Provider Demographics
NPI:1376128447
Name:SCHUPP-STAR, JOSHUA TZVI (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TZVI
Last Name:SCHUPP-STAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SAINT PAUL ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8462
Mailing Address - Country:US
Mailing Address - Phone:802-216-0727
Mailing Address - Fax:802-633-0956
Practice Address - Street 1:125 SAINT PAUL ST STE 103
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8686
Practice Address - Country:US
Practice Address - Phone:802-216-0727
Practice Address - Fax:802-633-0956
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055.0031537363A00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant