Provider Demographics
NPI:1740619311
Name:LOWRY, SHAE LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHAE
Middle Name:LYNN
Last Name:LOWRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SHAE
Other - Middle Name:LYNN
Other - Last Name:BURKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:640 KOLTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3570
Mailing Address - Country:US
Mailing Address - Phone:724-357-7196
Mailing Address - Fax:724-357-7279
Practice Address - Street 1:1265 WAYNE AVE STE 107
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3501
Practice Address - Country:US
Practice Address - Phone:724-463-9702
Practice Address - Fax:724-463-1046
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056592363A00000X
PAOA003175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103143430Medicaid