Healthcare Provider Details

I. General information

NPI: 1750944526
Provider Name (Legal Business Name): SILVERPATH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E. TOWNSHIP LINE ROAD SUITE 135, TOWER 4
BLUE BELL PA
19422-2700
US

IV. Provider business mailing address

22 WESTEDGE ST STE 800
CHARLESTON SC
29403-6984
US

V. Phone/Fax

Practice location:
  • Phone: 854-429-1069
  • Fax: 833-247-4091
Mailing address:
  • Phone: 854-429-1069
  • Fax: 833-247-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SHEA HARRELSON
Title or Position: CEO/CO-OWNER
Credential:
Phone: 854-429-1069