Healthcare Provider Details

I. General information

NPI: 1164745683
Provider Name (Legal Business Name): DAWN M SQUILLANTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN M SCHLEMBACK

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE STE 370
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

100 E LANCASTER AVE STE 370
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 610-642-3005
  • Fax: 610-642-3057
Mailing address:
  • Phone: 610-642-3005
  • Fax: 610-642-3057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA003050L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: