Provider Demographics
NPI:1124029939
Name:SHUEY, YELENA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:YELENA
Middle Name:
Last Name:SHUEY
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 1:3340 EAST GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:6533 EMERALD STREET
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8737
Practice Address - Country:US
Practice Address - Phone:208-367-4170
Practice Address - Fax:208-367-8135
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00860363A00000X
IDPA-400363A00000X
ID363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8078874900Medicaid
ID807884901Medicaid
ID1667142Medicare PIN
IDP82814Medicare UPIN
ID807884901Medicaid
ORR115235Medicare PIN
ID8078874900Medicaid