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General NPI Number Information
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NPI Number | 1568404143
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Entity Type | Individual
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Provider Name | SHANNON L. VITELLI DO
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Gender | Female
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 17 IRON BRIDGE DR STE 100
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-2042
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Country | US
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Telephone | 484-622-6340
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Fax | 484-622-6357
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Provider Business Mailing Address
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Address Line | 17 IRON BRIDGE DR STE 100
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-2042
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Country | US
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Telephone | 610-489-5782
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Fax | 610-489-6418
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | OS011868
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License Number State | PA
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