Individual
MISS FAFA TSIKATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
428 ORCHARD AVE, YEADON, PA 19050-3114
(484) 343-0260
Mailing address
113 N FRONT ST, LEWISBURG, PA 17837-1507
(484) 343-0260
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
RT005186
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200005221
BOARD OF CERTIFICATION
—
01
—
RT005186
PENNSYLVANIA BOARD OF MEDICINE
PA
Enumeration date
05/16/2017
Last updated
05/16/2017
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