Provider Demographics
NPI:1053453118
Name:ADSHEAD, ANITA FRANCINE (PA-C)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:FRANCINE
Last Name:ADSHEAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR1-BOX1790A
Mailing Address - Street 2:
Mailing Address - City:KUNKLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18058
Mailing Address - Country:US
Mailing Address - Phone:570-620-9192
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLAZA
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-240-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003275-01363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical