Healthcare Provider Details

I. General information

NPI: 1740431584
Provider Name (Legal Business Name): SANDRA L MOFFETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

1671 CROOKED OAK DR
LANCASTER PA
17601-4269
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-1455
  • Fax:
Mailing address:
  • Phone: 717-569-5331
  • Fax: 717-569-4210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA053686
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: