Provider Demographics
NPI:1871218198
Name:SCHIRRA, KALI AMANDA (PA-C)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:AMANDA
Last Name:SCHIRRA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:RANSOM TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9546
Mailing Address - Country:US
Mailing Address - Phone:570-575-5287
Mailing Address - Fax:
Practice Address - Street 1:8 BROOKHILL SQ S
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249-1010
Practice Address - Country:US
Practice Address - Phone:570-459-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMA063953363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty