Healthcare Provider Details

I. General information

NPI: 1629359070
Provider Name (Legal Business Name): SHANNON A BERTSCHE PA-C, MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD BUILDING SUITE 300
SALINAS CA
93906
US

IV. Provider business mailing address

1441 CONSTITUTION BLVD BUILDING 400 SUITE 300
SALINAS CA
93906
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4123
  • Fax:
Mailing address:
  • Phone: 402-202-5605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: