Provider Demographics
NPI:1083162325
Name:DEVINNEY, SHELBY DURRANCE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:DURRANCE
Last Name:DEVINNEY
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 1:1218 MILLENNIUM PKWY
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-3895
Mailing Address - Country:US
Mailing Address - Phone:813-684-5255
Mailing Address - Fax:813-654-7457
Practice Address - Street 1:1218 MILLENNIUM PKWY
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-3895
Practice Address - Country:US
Practice Address - Phone:813-684-5255
Practice Address - Fax:813-654-7457
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9109642363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical