Lisa Marie Shallenberger, MMS, PA-C
Physician Assistant in Lake Mary, FL. Individual provider (NPI-1).
NPI number1366969578
StatusActive
Last updated in NPPESJul 3, 2024
Details
- NPI
- 1366969578
- Entity type
- Individual (NPI-1)
- Name
- Ms. Lisa Marie Shallenberger
- Credential
- MMS, PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 28, 2017
- Certification date
- Jul 3, 2024
- Last updated
- Jul 3, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | PA9110578 | FL | Yes |
Practice location
4106 W Lake Mary Blvd Ste 205Lake Mary, FL 32746-3344
Phone 407-851-5121
Mailing address
859 Silverado CtLake Mary, FL 32746-4966
Phone 786-301-2626
Other practice locations
3798 Irvington Ave
Coconut Grove, FL 33133-6106
Coconut Grove, FL 33133-6106
Phone 786-301-2626 · Fax 786-301-2626
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