Provider Demographics
NPI:1972912947
Name:CHEDIAK, MARGO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARGO
Middle Name:
Last Name:CHEDIAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MARGO
Other - Middle Name:
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:631 SW HORNE ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1694
Mailing Address - Country:US
Mailing Address - Phone:785-295-7878
Mailing Address - Fax:785-234-6301
Practice Address - Street 1:631 SW HORNE ST
Practice Address - Street 2:SUITE 420
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1694
Practice Address - Country:US
Practice Address - Phone:785-295-7878
Practice Address - Fax:785-234-6301
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01260363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical