MEDICARE: ROBIN MICHELLE SHAVER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	TL1343	SC

General Provider Information

NPI Number	:	1942453139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN MICHELLE SHAVER PA

Provider Business Mailing Address
First Line	:	158A EASTCLIFF DR SE
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-3719
Country	:	US
Telephone Number	:	704-433-7579
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 21ST AVE N
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-7402
Country	:	US
Telephone Number	:	843-626-9379
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2008
Last Update Date	:	12/18/2019

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