MEDICARE: MRS. HOLLY R SHESKY PAC

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	363AM0700X	Medical Physician Assistant	5601003647	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255327466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY R SHESKY PAC

Provider Business Mailing Address
First Line	:	1447 N HARRISON ST
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48602-4727
Country	:	US
Telephone Number	:	989-583-2833
Fax Number	:	989-583-1440

Provider Business Practice Location Address
First Line	:	900 COOPER AVE
Second Line	:	SUITE 4100
City	:	SAGINAW
State	:	MI
Zip	:	48602-5182
Country	:	US
Telephone Number	:	989-497-9395
Fax Number	:	989-583-7173

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	01/18/2021

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Directions to “ MRS. HOLLY R SHESKY PAC” Practice Location

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