Healthcare Provider Details

I. General information

NPI: 1497226997
Provider Name (Legal Business Name): ASHLEY SHANNON ROBINSON-MEDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2018
Last Update Date: 12/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S 4TH ST STE 248
PHILADELPHIA PA
19147-1573
US

IV. Provider business mailing address

525 S 4TH ST STE 248
PHILADELPHIA PA
19147-1573
US

V. Phone/Fax

Practice location:
  • Phone: 267-997-7015
  • Fax:
Mailing address:
  • Phone: 267-997-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: