Provider Demographics
NPI:1255314928
Name:AMIN, ANASTACIA KAY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANASTACIA
Middle Name:KAY
Last Name:AMIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ANASTACIA
Other - Middle Name:KAY
Other - Last Name:SHAVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3000 Q ST
Mailing Address - Street 2:DEPT OF UROLOGY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7058
Mailing Address - Country:US
Mailing Address - Phone:916-733-3310
Mailing Address - Fax:916-733-5378
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3310
Practice Address - Fax:916-733-5378
Is Sole Proprietor?:No
Enumeration Date:2005-11-27
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19329363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ975211Medicaid
AZ106646Medicare ID - Type Unspecified
AZ975211Medicaid