Basic Information
| Provider Information | |||||||||
| NPI: | 1770121832 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHUKRY | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C, M.S.P.A.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178224903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716144 | ||||||||
| FaxNumber: | 5702716578 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 W FRONT ST | ||||||||
| Address2: | |||||||||
| City: | BERWICK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186034106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707591228 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2019 | ||||||||
| LastUpdateDate: | 02/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MA061338 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OA005148 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 363A00000X | MA061338 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.