Provider Demographics
NPI:1588843874
Name:HUNT, SHALECHIA A (PA)
Entity Type:Individual
Prefix:
First Name:SHALECHIA
Middle Name:A
Last Name:HUNT
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 1:16519 VICTOR ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3965
Mailing Address - Country:US
Mailing Address - Phone:760-955-9555
Mailing Address - Fax:760-955-8558
Practice Address - Street 1:16519 VICTOR ST
Practice Address - Street 2:SUITE 307
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3965
Practice Address - Country:US
Practice Address - Phone:760-955-9555
Practice Address - Fax:760-955-8558
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19445363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19445OtherSTATE LICENSE