Provider Demographics
NPI:1700513025
Name:SHULSKI, AMANDA MARGARET (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARGARET
Last Name:SHULSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:158 LISMORE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4021
Mailing Address - Country:US
Mailing Address - Phone:267-516-8128
Mailing Address - Fax:
Practice Address - Street 1:4190 CITY AVE STE 528
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1635
Practice Address - Country:US
Practice Address - Phone:866-453-8800
Practice Address - Fax:844-734-7689
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOA006194363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical