MEDICARE: MR. ADAM HOWARD SHIFFMAN PA-C

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
1	363A00000X	Physician Assistant	0110002612	VA
2	363A00000X	Physician Assistant	PA21014	CA

General Provider Information

NPI Number	:	1154516490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADAM HOWARD SHIFFMAN PA-C

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:	ATTN: CREDENTIALING/PAYER ENROLLMENT
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7926
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4598 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112
Country	:	US
Telephone Number	:	415-965-7941
Fax Number	:	415-965-7935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	07/05/2018

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Directions to “ MR. ADAM HOWARD SHIFFMAN PA-C” Practice Location

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