MEDICARE: CHRISTINA L CHAMBLEY 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	MA050858	PA

General Provider Information

NPI Number	:	1568463073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA L CHAMBLEY PA-C

Provider Business Mailing Address
First Line	:	151 SOUTHHALL LN
Second Line	:	STE 300
City	:	MAITLAND
State	:	FL
Zip	:	32751-7172
Country	:	US
Telephone Number	:	407-875-2080
Fax Number	:	407-650-3455

Provider Business Practice Location Address
First Line	:	8001 ROOSEVELT BLVD
Second Line	:	SUITE 307
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3038
Country	:	US
Telephone Number	:	267-731-1333
Fax Number	:	267-731-1284

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/13/2017

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