Provider Demographics
NPI:1518567783
Name:STEWART, SHELBY (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE C528
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6848
Mailing Address - Country:US
Mailing Address - Phone:972-331-1900
Mailing Address - Fax:972-331-1909
Practice Address - Street 1:7777 FOREST LN STE C528
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6848
Practice Address - Country:US
Practice Address - Phone:972-331-1900
Practice Address - Fax:972-331-1909
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA143436363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant