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General NPI Number Information
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NPI Number | 1467491258
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Entity Type | Individual
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Provider Name | CYNTHIA JAYNE SHALBY PA
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Gender | Female
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 550 E WASHINGTON BLVD SUITE 100
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City | CRESCENT CITY
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State | CA
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Zip | 95531-8160
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Country | US
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Telephone | 707-826-8633
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Fax |
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Provider Business Mailing Address
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Address Line | 550 E WASHINGTON BLVD SUITE 100
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City | CRESCENT CITY
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State | CA
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Zip | 95531-8160
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Country | US
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Telephone | 707-826-6633
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1646
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1500388
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License Number State | KS
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