Healthcare Provider Details

I. General information

NPI: 1780142166
Provider Name (Legal Business Name): KAYLEIGH MORGAN SHAVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 OLD MOULTRIE RD
ST AUGUSTINE FL
32086-5102
US

IV. Provider business mailing address

PO BOX 13834
TALLAHASSEE FL
32317-3834
US

V. Phone/Fax

Practice location:
  • Phone: 904-877-1300
  • Fax: 904-506-2005
Mailing address:
  • Phone: 850-205-6232
  • Fax: 855-975-0615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: