Provider Demographics
NPI:1144192907
Name:SHILLINGBURG, CHARLES
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SHILLINGBURG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 PETERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:ENON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:16120-1427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 PETERSBURG RD
Practice Address - Street 2:
Practice Address - City:ENON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:16120-1427
Practice Address - Country:US
Practice Address - Phone:724-510-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer