Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

MS. Lisa Marie Shallenberger, MMS, PA-C

Individual provider Physician Assistant · NPI 1366969578

MS. Lisa Marie Shallenberger, MMS, PA-C is a Physician Assistant in Lake Mary, Florida. Qualified in 2018, 8 years ago. Practices with Mava Healthcare Systems LLC, a 6-clinician group, works from 2 locations and offers telehealth. Licensed in Florida.

Years since qualifying
8
Licensed in
FL
In the registry since
2017
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

4106 W Lake Mary Blvd Ste 205
Lake Mary, FL 32746-3344
Phone: (407) 851-5121
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3798 Irvington Ave, Coconut Grove, FL 33133-6106 — (786) 301-2626

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9110578 (FL)

Record details

NPI number1366969578
Entity typeIndividual (Type 1)
GenderFemale
Credentials MMS , PA-C
Sole proprietorNo
NPI enumeratedAugust 28, 2017
Last updated in NPPESJuly 3, 2024
Certification dateJuly 3, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Mava Healthcare Systems Llc — 6 clinicians
Accepts Medicare assignment Not indicated
TelehealthOffers telehealth services

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