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General NPI Number Information
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NPI Number | 1720401029
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Entity Type | Individual
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Provider Name | DEONNA SHROUT
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Gender | Female
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 118 E 2ND ST
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City | ERIE
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State | PA
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Zip | 16507-1502
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Country | US
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Telephone | 412-926-2433
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 PEACH ST SUITE 200
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City | ERIE
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State | PA
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Zip | 16501-2134
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Country | US
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Telephone |
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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 | MA056426
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License Number State | PA
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