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General NPI Number Information
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NPI Number | 1528722469
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Entity Type | Individual
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Provider Name | SHANE KALETTE PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 6 E LANCASTER AVE UPPR LEVEL
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City | WYNNEWOOD
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State | PA
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Zip | 19096-3430
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Country | US
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Telephone | 484-380-2808
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Fax | 484-416-3942
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Provider Business Mailing Address
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Address Line | 825 OLD LANCASTER RD STE 320
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City | BRYN MAWR
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State | PA
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Zip | 19010-3235
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Country | US
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Telephone | 610-527-3800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA063045
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License Number State | PA
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