Healthcare Provider Details

I. General information

NPI: 1205502978
Provider Name (Legal Business Name): SHELBY ELIZABETH NYCZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELBY ELIZABETH NEIL PA-C

II. Dates (important events)

Enumeration Date: 08/21/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 HODGSON CT
SAVANNAH GA
31406-1520
US

IV. Provider business mailing address

340 HODGSON CT
SAVANNAH GA
31406-1520
US

V. Phone/Fax

Practice location:
  • Phone: 912-629-2290
  • Fax:
Mailing address:
  • Phone: 912-629-2290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61218979
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number13941
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: