MEDICARE: SHEENA AMIN SHAH PHYSICIAN ASSISTANT

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	PA59071	CA
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1528659984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEENA AMIN SHAH PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	9025 SYDNEY CT UNIT 12302
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1624
Country	:	US
Telephone Number	:	909-456-6969
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 EUCLID AVE STE 204
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-2949
Country	:	US
Telephone Number	:	619-331-3992
Fax Number	:

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

Provider Enumeration Date	:	01/28/2021
Last Update Date	:	07/27/2021

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