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NPI Code Detail

MEDICARE: KRISTIE SHORES PA-C

MEDICARE: KRISTIE SHORES 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
1363A00000XPhysician AssistantMA060130PA
2363AM0700XMedical Physician AssistantMA060130PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MA060130OTHERPASTATE LICENSE

General Provider Information

NPI Number : 1942784319
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIE SHORES PA-C
Provider Business Mailing Address
First Line : 1605 N CEDAR CREST BLVD STE 411
Second Line :
City : ALLENTOWN
State : PA
Zip : 18104-2323
Country : US
Telephone Number : 484-330-1377
Fax Number :
Provider Business Practice Location Address
First Line : 7096 DECATUR ST
Second Line :
City : NEW TRIPOLI
State : PA
Zip : 18066-3815
Country : US
Telephone Number : 610-298-8521
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2018
Last Update Date : 07/21/2025

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Directions to “ KRISTIE SHORES PA-C” Practice Location

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