Healthcare Provider Details

I. General information

NPI: 1295746642
Provider Name (Legal Business Name): ILAINA SPINELLI MOYER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ILAINA MICHELLE SPINELLI

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-4000
  • Fax:
Mailing address:
  • Phone: 215-662-4000
  • Fax: 215-615-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA052593
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: