Provider Demographics
NPI:1255443933
Name:SHIFFER, ELLEN L (PA-C)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:SHIFFER
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 1:1208 ONEILL HWY
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-1709
Mailing Address - Country:US
Mailing Address - Phone:570-499-3919
Mailing Address - Fax:570-207-2616
Practice Address - Street 1:1208 ONEILL HWY
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-1709
Practice Address - Country:US
Practice Address - Phone:570-207-2612
Practice Address - Fax:570-207-2616
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003326L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50057341OtherCAPITAL BC
PAP55999Medicare UPIN
PA069522Medicare PIN
PAP00013498Medicare PIN
PA267760ZCPNMedicare PIN
PA146956 RQJMedicare PIN