MEDICARE: BROOKE LEE ZDROSKY SHONTZ PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		PA

General Provider Information

NPI Number	:	1205277126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE LEE ZDROSKY SHONTZ PA-C

Provider Business Mailing Address
First Line	:	10663 RAYSTOWN RD
Second Line	:
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-7542
Country	:	US
Telephone Number	:	814-627-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	10663 RAYSTOWN RD
Second Line	:
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-7542
Country	:	US
Telephone Number	:	814-627-0071
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	02/29/2016

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