Provider Demographics
NPI:1508941436
Name:BABICH, SHELLIE SUE (PA)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:SUE
Last Name:BABICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHELLIE
Other - Middle Name:SUE
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1240 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-2217
Mailing Address - Country:US
Mailing Address - Phone:707-465-5566
Mailing Address - Fax:707-465-4990
Practice Address - Street 1:1240 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-2217
Practice Address - Country:US
Practice Address - Phone:707-465-5566
Practice Address - Fax:707-465-4990
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15488363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29212ZMedicare ID - Type Unspecified