Healthcare Provider Details

I. General information

NPI: 1336807734
Provider Name (Legal Business Name): REBECCA ANN GODSTREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BRADDOCK AVE
BRADDOCK PA
15104-1856
US

IV. Provider business mailing address

501 BRADDOCK AVE
BRADDOCK PA
15104-1856
US

V. Phone/Fax

Practice location:
  • Phone: 412-636-5050
  • Fax: 412-271-2361
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA063106
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: