Provider Demographics
NPI:1255327466
Name:SHESKY, HOLLY R (PAC)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:R
Last Name:SHESKY
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-2833
Mailing Address - Fax:989-583-1440
Practice Address - Street 1:900 COOPER AVE
Practice Address - Street 2:SUITE 4100
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5182
Practice Address - Country:US
Practice Address - Phone:989-497-9395
Practice Address - Fax:989-583-7173
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003647363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1255327466Medicaid
MIM74750249Medicare PIN