MEDICARE: SHELBY HANNAH KAMINSKY 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	9112443	FL
2	363AM0700X	Medical Physician Assistant	9112443	FL
3	363AS0400X	Surgical Physician Assistant	9112443	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1165482	OTHER		NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
2	9112443	OTHER	FL	FLORIDA DEPARTMENT OF HEALTH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336798503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY HANNAH KAMINSKY PA-C

Provider Business Mailing Address
First Line	:	1609 PASADENA AVE S STE 3M
Second Line	:
City	:	SOUTH PASADENA
State	:	FL
Zip	:	33707-4563
Country	:	US
Telephone Number	:	727-289-7137
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 PASADENA AVE S STE 3M
Second Line	:
City	:	SOUTH PASADENA
State	:	FL
Zip	:	33707-4563
Country	:	US
Telephone Number	:	727-289-7137
Fax Number	:

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

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	09/10/2019

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