Provider Demographics
NPI:1447580535
Name:MAIER, SHELLEY RAE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:RAE
Last Name:MAIER
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 1:3130 N DIXIE HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1337
Mailing Address - Country:US
Mailing Address - Phone:937-339-7982
Mailing Address - Fax:937-339-7842
Practice Address - Street 1:3130 N DIXIE HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-339-7982
Practice Address - Fax:937-339-7842
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001420363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical