Healthcare Provider Details

I. General information

NPI: 1952620676
Provider Name (Legal Business Name): JOY SHALOMA ELLIOTT-DEMARS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOY SHALOMA ELLIOTT PA-C

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 PRECISSI LN
STOCKTON CA
95207-6239
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 209-477-4103
  • Fax: 209-477-1065
Mailing address:
  • Phone: 408-795-3619
  • Fax: 408-287-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: