Provider Demographics
NPI:1518186378
Name:ULSHAFER, ANDREA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:ULSHAFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:K
Other - Last Name:ULSHAFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:14 N KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:MCADOO
Mailing Address - State:PA
Mailing Address - Zip Code:18237-1908
Mailing Address - Country:US
Mailing Address - Phone:570-645-1880
Mailing Address - Fax:
Practice Address - Street 1:14 N KENNEDY DR
Practice Address - Street 2:
Practice Address - City:MCADOO
Practice Address - State:PA
Practice Address - Zip Code:18237-1908
Practice Address - Country:US
Practice Address - Phone:570-645-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001082L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS35524Medicare UPIN