Healthcare Provider Details

I. General information

NPI: 1982517942
Provider Name (Legal Business Name): SHELBY YEAKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 PENN AVE FL 1
SCRANTON PA
18503-1963
US

IV. Provider business mailing address

1459 MOUNT COBB RD APT A
JEFFERSON TOWNSHIP PA
18436-3226
US

V. Phone/Fax

Practice location:
  • Phone: 570-558-0290
  • Fax:
Mailing address:
  • Phone: 816-262-8907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE013622
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: