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General NPI Number Information
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NPI Number | 1336798503
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Entity Type | Individual
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Provider Name | SHELBY HANNAH KAMINSKY PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 1609 PASADENA AVE S STE 3M
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-4563
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Country | US
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Telephone | 727-289-7137
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Fax |
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Provider Business Mailing Address
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Address Line | 1609 PASADENA AVE S STE 3M
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-4563
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Country | US
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Telephone | 727-289-7137
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9112443
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9112443
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 9112443
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License Number State | FL
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