Provider Demographics
NPI:1073728093
Name:SHALHOUB, CATHARINE CECILIA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:CATHARINE
Middle Name:CECILIA
Last Name:SHALHOUB
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:111 ALPINE DR
Mailing Address - Street 2:SUITE #8
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1111
Mailing Address - Country:US
Mailing Address - Phone:315-449-2326
Mailing Address - Fax:
Practice Address - Street 1:614 S SALINA ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3524
Practice Address - Country:US
Practice Address - Phone:315-425-0599
Practice Address - Fax:315-471-6760
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008872363A00000X, 363AM0700X
NJ25MP00251200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical