MEDICARE: KELLEY L. PASTOR PA-C

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	50.002708	OH

General Provider Information

NPI Number	:	1245411495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY L. PASTOR PA-C

Provider Business Mailing Address
First Line	:	9485 MENTOR AVENUE
Second Line	:	SUITE 210
City	:	MENTOR
State	:	OH
Zip	:	44060-8713
Country	:	US
Telephone Number	:	440-205-5848
Fax Number	:	440-255-5548

Provider Business Practice Location Address
First Line	:	9220 MENTOR AVE
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-6412
Country	:	US
Telephone Number	:	440-354-9924
Fax Number	:	877-242-9583

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

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	09/01/2021

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Directions to “ KELLEY L. PASTOR PA-C” Practice Location

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