Provider Demographics
NPI:1013396779
Name:BURTON, SHELBY RAE
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:RAE
Last Name:BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:RAE
Other - Last Name:CARTWRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:701 N WENDY DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3066
Mailing Address - Country:US
Mailing Address - Phone:805-375-4400
Mailing Address - Fax:
Practice Address - Street 1:701 N WENDY DR STE 400
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3066
Practice Address - Country:US
Practice Address - Phone:805-375-4400
Practice Address - Fax:805-375-4424
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10664Medicare PIN