Provider Demographics
NPI:1467706333
Name:SHLIFER, INESSA (PA)
Entity Type:Individual
Prefix:
First Name:INESSA
Middle Name:
Last Name:SHLIFER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12786-0032
Mailing Address - Country:US
Mailing Address - Phone:914-907-3864
Mailing Address - Fax:
Practice Address - Street 1:113 MOSCOE RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:NY
Practice Address - Zip Code:12786
Practice Address - Country:US
Practice Address - Phone:914-907-3864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005355363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty