Healthcare Provider Details

I. General information

NPI: 1730177643
Provider Name (Legal Business Name): ANDREA SCHELLENBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S CEDAR CREST BLVD BOX 689
ALLENTOWN PA
18105
US

IV. Provider business mailing address

24 S 18TH ST
ALLENTOWN PA
18104-5622
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-9080
  • Fax: 610-402-9029
Mailing address:
  • Phone: 610-628-8372
  • Fax: 610-628-8648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD063708L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: