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General NPI Number Information
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NPI Number | 1871533240
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Entity Type | Individual
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Provider Name | ALISSA JAN SHAVALIER PAC
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 1112 GOODLETTE RD N STE 204
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City | NAPLES
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State | FL
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Zip | 34102-5499
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Country | US
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Telephone | 239-262-4519
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Fax | 239-262-5672
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Provider Business Mailing Address
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Address Line | 1112 GOODLETTE RD N STE 204
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City | NAPLES
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State | FL
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Zip | 34102-5499
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Country | US
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Telephone | 239-262-4519
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Fax | 239-262-5672
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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 | PA9103314
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License Number State | FL
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