Healthcare Provider Details

I. General information

NPI: 1255118915
Provider Name (Legal Business Name): SHANE FIORENTINI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 HAYMAKER RD STE 102
MONROEVILLE PA
15146-3500
US

IV. Provider business mailing address

2580 HAYMAKER RD STE 102
MONROEVILLE PA
15146-3500
US

V. Phone/Fax

Practice location:
  • Phone: 412-858-7766
  • Fax:
Mailing address:
  • Phone: 412-858-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA065098
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: