NPI | 1003993916 |
---|---|
Former Name | AMANDA E SHELLEY-AYALA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3264) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 52291) |
Enumeration Date | 2006-11-01 |
Last Update Date | 2015-11-04 |