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NPI Code Detail

MEDICARE: JAMIE LYNN SHEDELBOWER PA

MEDICARE: JAMIE LYNN SHEDELBOWER PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363AS0400XSurgical Physician Assistant

General Provider Information

NPI Number : 1033115480
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE LYNN SHEDELBOWER PA
Provider Business Mailing Address
First Line : 915 N GRAND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63106-1621
Country : US
Telephone Number : 314-289-6376
Fax Number :
Provider Business Practice Location Address
First Line : 915 N GRAND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63106-1621
Country : US
Telephone Number : 314-289-6376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 04/03/2024

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