Healthcare Provider Details

I. General information

NPI: 1689113383
Provider Name (Legal Business Name): ALLYSON SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST 3 SILVERSTEIN
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3400 SPRUCE ST 3 SILVERSTEIN
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3487
  • Fax: 215-349-5534
Mailing address:
  • Phone: 215-662-3487
  • Fax: 215-349-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.005006RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061695
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: