Individual
SHANNON L. VITELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
17 IRON BRIDGE DR STE 100, COLLEGEVILLE, PA 19426-2042
(484) 622-6340
(484) 622-6357
Mailing address
17 IRON BRIDGE DR, STE 100, COLLEGEVILLE, PA 19426-2042
(610) 489-5782
(610) 489-6418
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OS011868
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019807030001
OMAP
PA
01
—
11212082
CAQH ID#
PA
01
—
1523072
HIGHMARK BLUE SHIELD
PA
01
—
2209467000
IBC - PC/KHPE
PA
01
—
30010139
KEYSTONE MERCY
PA
01
—
3373024
AETNA HMO
PA
01
—
36156-OS011868
HEALTH PARTNERS
PA
01
—
7402478
AETNA PPO
PA
01
—
9514702
CIGNA HMO/PPO
PA
Enumeration date
06/11/2006
Last updated
06/30/2021
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