Individual
RANDI L. SHUPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
250 CETRONIA ROAD, SUITE 303, ALLENTOWN, PA 18104-9168
(610) 973-6200
(610) 973-6546
Mailing address
PO BOX 783311, PHILADELPHIA, PA 19178-3311
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA051867
PA
363AM0700X
Medical Physician Assistant
Primary
MA051867
PA
363AS0400X
Surgical Physician Assistant
MA051867
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50053681
BLUE CROSS
PA
Enumeration date
09/06/2005
Last updated
12/23/2015
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