Healthcare Provider Details

I. General information

NPI: 1538095310
Provider Name (Legal Business Name): JOSHUA EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PHILADELPHIA AVE UNIT 1
SHILLINGTON PA
19607-2757
US

IV. Provider business mailing address

5135 ROUTE 115
BLAKESLEE PA
18610-7850
US

V. Phone/Fax

Practice location:
  • Phone: 610-871-3856
  • Fax:
Mailing address:
  • Phone: 484-707-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: