Provider Demographics
NPI:1164456083
Name:RAJA, SABRINA SHAHEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:SHAHEEN
Last Name:RAJA
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:PO BOX 8676
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29604-8676
Mailing Address - Country:US
Mailing Address - Phone:864-232-7338
Mailing Address - Fax:864-239-6645
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:SUITE B 200
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6321
Practice Address - Country:US
Practice Address - Phone:864-232-7338
Practice Address - Fax:864-239-6645
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103691363A00000X
SC1354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP81347Medicare UPIN