Healthcare Provider Details

I. General information

NPI: 1932935848
Provider Name (Legal Business Name): SHANNON KUHN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 FOURTH STREET P.O BOX 727
EAST BERLIN PA
17316
US

IV. Provider business mailing address

725 RIFE RD
EAST BERLIN PA
17316-9554
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-4900
  • Fax:
Mailing address:
  • Phone: 717-357-7919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: