Provider Demographics
NPI:1851630735
Name:PARLLAKU, LILLY MOSS (PA-C)
Entity Type:Individual
Prefix:
First Name:LILLY
Middle Name:MOSS
Last Name:PARLLAKU
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 1:775 E LANCASTER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1529
Mailing Address - Country:US
Mailing Address - Phone:610-525-7800
Mailing Address - Fax:
Practice Address - Street 1:775 E LANCASTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1529
Practice Address - Country:US
Practice Address - Phone:610-525-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056526363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical