| NPI | 1467698621 |
|---|---|
| Former Name | SHELLEY M BURTT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TL2725) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 013354) |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2017-04-06 |