Provider Demographics
NPI:1407143993
Name:SHADZEKA, NOELLA YEFON (PA)
Entity type:Individual
Prefix:
First Name:NOELLA
Middle Name:YEFON
Last Name:SHADZEKA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NOELLA
Other - Middle Name:
Other - Last Name:SHADZEKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:500 UNIVERSITY DR MC CA410
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-5208
Mailing Address - Fax:717-531-0119
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-8521
Practice Address - Fax:717-531-5068
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC04491363AM0700X
PAMA064260363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical