MEDICARE: MISS SHEENA KATHLEEN RETTALIATA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA062586	PA

General Provider Information

NPI Number	:	1225372618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHEENA KATHLEEN RETTALIATA PA

Provider Business Mailing Address
First Line	:	2200 ST LUKES BLVD STE 100
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5665
Country	:	US
Telephone Number	:	484-884-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 ST LUKES BLVD STE 100
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5665
Country	:	US
Telephone Number	:	484-884-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	10/30/2025

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