Provider Demographics
NPI:1215599188
Name:MAINGI, SHADRACK MASOO-WAITA (PA-C)
Entity Type:Individual
Prefix:
First Name:SHADRACK
Middle Name:MASOO-WAITA
Last Name:MAINGI
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:125 STONY HILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01036-9717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:819 WORCESTER ST STE 1
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01151-1056
Practice Address - Country:US
Practice Address - Phone:413-304-2501
Practice Address - Fax:413-789-0290
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical