Individual
ELLYSSA SUSAN DEGROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1240 S CEDAR CREST BLVD STE 403, ALLENTOWN, PA 18103-6218
(610) 402-3650
Mailing address
1240 S CEDAR CREST BLVD STE 403, ALLENTOWN, PA 18103-6218
(610) 402-3650
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA059299
PA
Other
Enumeration date
09/28/2017
Last updated
09/28/2017
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