NPI | 1215932702 |
---|---|
Former Name | SANDRA M SHELBY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60467722) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601001357) |
363A00000X Physician Assistant (Licence: NC 0010-03212) | |
363AM0700X Physician Assistant, Medical (Licence: WA PA60467722) | |
Enumeration Date | 2005-06-20 |
Last Update Date | 2022-06-15 |