Provider Demographics
NPI:1548986003
Name:SHOPE, GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:SHOPE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:GODSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:
Practice Address - Street 1:14351 KUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522-9273
Practice Address - Country:US
Practice Address - Phone:610-944-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064117363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical