Individual
GENESEE MAYLEE VILLALTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
500 UNIVERSITY DR, HERSHEY, PA 17033-2360
(717) 531-6820
(717) 531-4702
Mailing address
500 UNIVERSITY DR MC CA410, HERSHEY, PA 17033-2360
(717) 531-5208
(717) 531-0119
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
363A00000X
Physician Assistant
Primary
MA067758
PA
363AM0700X
Medical Physician Assistant
PA61474
CA
Other
Enumeration date
06/30/2022
Last updated
06/19/2026
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