Provider Demographics
NPI:1164404786
Name:MURPHY, SHAYLYN B (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAYLYN
Middle Name:B
Last Name:MURPHY
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 1:1620 E 12TH ST
Mailing Address - Street 2:PO BOX 1520
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058
Mailing Address - Country:US
Mailing Address - Phone:541-296-9151
Mailing Address - Fax:541-296-4710
Practice Address - Street 1:1620 E 12TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058
Practice Address - Country:US
Practice Address - Phone:541-296-9151
Practice Address - Fax:541-296-9156
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00919363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218112Medicaid
OR383996Medicare Oscar/Certification
P96834Medicare UPIN
ORR0000WFBCSMedicare PIN