Provider Demographics
NPI:1760036941
Name:SHUTY, ALYSON ROSE (PAC)
Entity Type:Individual
Prefix:MS
First Name:ALYSON
Middle Name:ROSE
Last Name:SHUTY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 S JULIAN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1918
Mailing Address - Country:US
Mailing Address - Phone:814-505-4889
Mailing Address - Fax:
Practice Address - Street 1:810 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6342
Practice Address - Country:US
Practice Address - Phone:814-946-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060677363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical