Provider Demographics
NPI:1528197241
Name:EPSTEIN, SHELLEY J (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:J
Last Name:EPSTEIN
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 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 330 MOB WEST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-645-9093
Mailing Address - Fax:610-645-9476
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 330 MOB WEST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-645-9093
Practice Address - Fax:610-645-9476
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050981363AS0400X, 363AS0400X
MDC0005171363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-2359401OtherMHC TIN
PA23-2359401OtherMHC TIN