Healthcare Provider Details

I. General information

NPI: 1629485230
Provider Name (Legal Business Name): SHELLY TENG TENG HSIAO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 MIDDLEBURY RD DEPT OF
IOWA CITY IA
52245-2712
US

IV. Provider business mailing address

3640 MIDDLEBURY RD
IOWA CITY IA
52245-2712
US

V. Phone/Fax

Practice location:
  • Phone: 319-353-6314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number074457
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: