Provider Demographics
NPI:1639153901
Name:VILSACK, SHALINI K
Entity Type:Individual
Prefix:
First Name:SHALINI
Middle Name:K
Last Name:VILSACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6048 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-1279
Mailing Address - Country:US
Mailing Address - Phone:724-836-0802
Mailing Address - Fax:724-836-1190
Practice Address - Street 1:6048 ROUTE 30
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1279
Practice Address - Country:US
Practice Address - Phone:724-836-0802
Practice Address - Fax:724-836-1190
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01724963Medicaid
PAU67785Medicare UPIN
PA001464XQ7Medicare PIN