Provider Demographics
NPI:1073224812
Name:SHELANSKAS, DAVID JOHN (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:SHELANSKAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 S GRAND ST
Mailing Address - Street 2:
Mailing Address - City:WEST SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06093-3413
Mailing Address - Country:US
Mailing Address - Phone:860-796-1817
Mailing Address - Fax:
Practice Address - Street 1:BLDG 445
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09114
Practice Address - Country:US
Practice Address - Phone:860-796-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant