Healthcare Provider Details

I. General information

NPI: 1962043331
Provider Name (Legal Business Name): SHEA SHOVLIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 08/17/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HALKET ST STE 5600
PITTSBURGH PA
15213-3108
US

IV. Provider business mailing address

600 GRANT ST FL 58
PITTSBURGH PA
15219-2739
US

V. Phone/Fax

Practice location:
  • Phone: 412-641-7850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA063680
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: