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General NPI Number Information
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NPI Number | 1851801617
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Entity Type | Individual
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Provider Name | SHIRLEY WONG PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 1401 FAIRMONT ST
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City | WHITEHALL
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State | PA
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Zip | 18052-6015
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Country | US
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Telephone | 610-432-4122
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Fax |
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Provider Business Mailing Address
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Address Line | 2821 KINGSBRIDGE LN
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City | ALLENTOWN
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State | PA
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Zip | 18103-9275
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Country | US
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Telephone | 610-390-8698
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA059382
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License Number State | PA
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