Provider Demographics
NPI:1326224668
Name:CHAN, SHIRLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:CHAN
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 1:321 WALNUT ST # 221
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1927
Mailing Address - Country:US
Mailing Address - Phone:617-359-8887
Mailing Address - Fax:
Practice Address - Street 1:1094 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5255
Practice Address - Country:US
Practice Address - Phone:508-879-2550
Practice Address - Fax:508-820-9844
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA2049363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical