Individual
ADRIANA DISTANISLAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1850 E PARK AVE STE 312, STATE COLLEGE, PA 16803-6706
(814) 237-6600
(814) 237-5383
Mailing address
501 S 54TH ST, PHILADELPHIA, PA 19143-1900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA056368
PA
Other
Enumeration date
09/23/2013
Last updated
07/27/2017
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