Provider Demographics
NPI:1508573551
Name:SHEDLOCK, ALYSSA LOGAN (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LOGAN
Last Name:SHEDLOCK
Suffix:
Gender:F
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 1:309 HOYA AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-8001
Mailing Address - Country:US
Mailing Address - Phone:814-592-4148
Mailing Address - Fax:
Practice Address - Street 1:2 JENNIFER CT STE B
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7694
Practice Address - Country:US
Practice Address - Phone:717-218-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant