Individual provider Active NPI

Marry Shetayh, PA-C

  • Medical Physician Assistant
  • Allentown, PA
National Provider Identifier
1164235412
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA066533 Issued in PA
Practice address
1250 S Cedar Crest Blvd
Allentown, PA 18103-6224
Phone
(610) 402-8506
Fax
(610) 402-1682
NPI assigned
Jan 30, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X
Medical Physician Assistant 363AM0700X MA066533 PA Primary

Addresses

Primary practice location

1250 S Cedar Crest Blvd
Allentown, PA 18103-6224

Mailing address

2100 Mack Blvd FL 4
Allentown, PA 18103-5622
Phone (484) 884-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250523000909 PA Practitioner - Physician Assistant 2769901685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Drexel University College of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

1200 S Cedar Crest Blvd
Allentown, PA 18103-6202

1200 S Cedar Crest Blvd 3Rd FL Kasych
LVPG Burn Surgery
Allentown, PA 18103-6202
Phone (610) 402-8355

1200 S Cedar Crest Blvd FL
1 LVPG Nephrology
Allentown, PA 18103-6202
Phone (610) 402-8510

1210 S Cedar Crest Blvd
Allentown, PA 18103-6235
Phone (610) 402-3888

1250 S Cedar Crest Blvd
Allentown, PA 18103-6224

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA066533PAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Physician Group CurrentSince May 26, 2025 Accepting new patients
Lehigh Valley Physician Group CurrentSince May 26, 2025 Accepting new patients

Locations

2100 Mack Blvd
Fl 4
Allentown, PA 18103

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1164235412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 MACK BLVD FL 4",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181035622",
            "telephone_number": "484-884-4500",
            "fax_number": "484-884-0699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 S CEDAR CREST BLVD",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181036224",
            "telephone_number": "610-402-8506",
            "fax_number": "610-402-1682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHETAYH",
        "first_name": "MARRY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA066533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.