Provider Demographics
NPI:1003119447
Name:SHILEY, NICOLE ELAINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELAINE
Last Name:SHILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 GRAYSON RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3331
Mailing Address - Country:US
Mailing Address - Phone:717-920-5910
Mailing Address - Fax:717-920-5916
Practice Address - Street 1:6301 GRAYSON RD
Practice Address - Street 2:SUITE 9
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3331
Practice Address - Country:US
Practice Address - Phone:717-920-5910
Practice Address - Fax:717-920-5916
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054429363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical