Provider Demographics
NPI:1033863642
Name:FAY, SHAWN PATRICK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:PATRICK
Last Name:FAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2208 N LOCUST RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4114
Mailing Address - Country:US
Mailing Address - Phone:509-590-7521
Mailing Address - Fax:
Practice Address - Street 1:311 S 72ND AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-1661
Practice Address - Country:US
Practice Address - Phone:509-972-1818
Practice Address - Fax:509-225-2706
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61236567363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical