Provider Demographics
NPI:1053374199
Name:SHAPICH, TARA J (PA-C)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:J
Last Name:SHAPICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:J
Other - Last Name:TIFFANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:141 MEDICAL PARK LN
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-9112
Mailing Address - Country:US
Mailing Address - Phone:814-355-7322
Mailing Address - Fax:814-355-9604
Practice Address - Street 1:141 MEDICAL PARK LN
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-9112
Practice Address - Country:US
Practice Address - Phone:814-355-7322
Practice Address - Fax:814-355-9604
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051716363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical