Individual
LEE SHALAMAR SPAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
640 ALDEN ST, MEADVILLE, PA 16335
(814) 373-5266
(814) 373-5269
Mailing address
1034 GROVE ST, MEADVILLE, PA 16335-2945
(814) 373-5266
(814) 373-5269
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
OT013317
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101268168
—
PA
01
—
OS016003
LICENSE
PA
Enumeration date
08/24/2009
Last updated
04/10/2019
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