MEDICARE: SHELLEY BLAKER PA

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	363AM0700X	Medical Physician Assistant	MA053673	PA

General Provider Information

NPI Number	:	1326293523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY BLAKER PA

Provider Business Mailing Address
First Line	:	101 E OLNEY AVE
Second Line	:	SUITE 400
City	:	PHILA
State	:	PA
Zip	:	19120-2421
Country	:	US
Telephone Number	:	215-456-7000
Fax Number	:	215-254-3289

Provider Business Practice Location Address
First Line	:	5401 OLD YORK RD
Second Line	:	WILLOWCREST BLDG, 4TH FL
City	:	PHILA
State	:	PA
Zip	:	19141-3030
Country	:	US
Telephone Number	:	215-456-3953
Fax Number	:	215-456-5948

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

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	12/02/2008

Similar Medicare Providers

1508834250 — ROBERT A FISCHER MD
Practice Location Address:

5401 OLD YORK RD , KLEIN 331 ALBERT EINSTEIN MEDICAL CENTER
PHILA, PA
19141-3030

Practice Phone: 215-456-6948
Practice Fax: 215-455-1933

1558325993 — DR. JOEL M KUPFER MD
Practice Location Address:

5401 OLD YORK RD , KLEIN 404
PHILA, PA
19141-3030

Practice Phone: 215-456-7266
Practice Fax: 215-455-1933

1831130244 — MRS. ROBERTA VIRGINIA TURNER M.D.
Practice Location Address:

5401 OLD YORK RD , KLEIN 331
PHILA, PA
19141-3030

Practice Phone: 215-456-6527
Practice Fax: 215-455-1933

1609816354 — RUSSELL AMUNDSON MD
Practice Location Address:

5401 OLD YORK RD , SUITE 501
PHILA, PA
19141-3030

Practice Phone: 215-456-6127
Practice Fax:

1679599005 — TANDEEP K BHATTI DO
Practice Location Address:

5401 OLD YORK RD , KLEIN 404
PHILA, PA
19141-3030

Practice Phone: 215-456-7266
Practice Fax: 215-455-1933

1174663991 — MRS. CAROL N MARDER CRNP
Practice Location Address:

5401 OLD YORK RD , KLEIN 300
PHILA, PA
19141-3030

Practice Phone: 215-456-7190
Practice Fax: 215-456-3419

Directions to “ SHELLEY BLAKER PA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.