Provider Demographics
NPI:1366459224
Name:SHIRLEN, ANDREW MARK (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARK
Last Name:SHIRLEN
Suffix:
Gender:M
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 1:3000 NEW BERN AVE
Mailing Address - Street 2:HEART CENTER ADMINISTRATION
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1231
Mailing Address - Country:US
Mailing Address - Phone:919-350-7601
Mailing Address - Fax:919-350-7577
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:HEART CENTER ADMINISTRATION
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-350-7601
Practice Address - Fax:919-350-7577
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00321363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ62317Medicare UPIN
NC2765226Medicare ID - Type Unspecified