Healthcare Provider Details

I. General information

NPI: 1851895742
Provider Name (Legal Business Name): ANSLEY GRACE SCHULTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 KIDSPEACE DR
OREFIELD PA
18069
US

IV. Provider business mailing address

241 ROBERT MORRIS BLVD APT 402
ALLENTOWN PA
18104-4549
US

V. Phone/Fax

Practice location:
  • Phone: 610-799-7500
  • Fax:
Mailing address:
  • Phone: 407-403-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number478744
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number152765
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier112668600
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: