MEDICARE: SHELBY VERMEULEN

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	PA70094659	WA

General Provider Information

NPI Number	:	1720938541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY VERMEULEN

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	TOPPENISH
State	:	WA
Zip	:	98948-0190
Country	:	US
Telephone Number	:	509-865-2395
Fax Number	:	509-865-0757

Provider Business Practice Location Address
First Line	:	1608 ROAD 44
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-2667
Country	:	US
Telephone Number	:	509-543-9280
Fax Number	:	509-545-6275

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

Provider Enumeration Date	:	01/31/2026
Last Update Date	:	03/09/2026

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Directions to “ SHELBY VERMEULEN ” Practice Location

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