Healthcare Provider Details

I. General information

NPI: 1528551181
Provider Name (Legal Business Name): SHANE MICHAEL SWINK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 S CEDAR CREST BLVD STE 100
ALLENTOWN PA
18103-6373
US

IV. Provider business mailing address

1259 S CEDAR CREST BLVD STE 100
ALLENTOWN PA
18103-6373
US

V. Phone/Fax

Practice location:
  • Phone: 610-437-4134
  • Fax: 610-433-9690
Mailing address:
  • Phone: 610-437-4134
  • Fax: 610-433-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS021872
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberOT018645
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOT018645
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberOS021872
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: