MEDICARE: MS. KRISTINA MICHELLE SHOCK 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	MA056234	PA
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	MA056234	PA

General Provider Information

NPI Number	:	1649605197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTINA MICHELLE SHOCK PA-C

Provider Business Mailing Address
First Line	:	4003 PENN AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15224-1337
Country	:	US
Telephone Number	:	724-309-5095
Fax Number	:	724-765-5475

Provider Business Practice Location Address
First Line	:	4003 PENN AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15224-1337
Country	:	US
Telephone Number	:	724-309-5095
Fax Number	:	724-765-5475

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

Provider Enumeration Date	:	09/03/2013
Last Update Date	:	02/29/2024

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