Provider Demographics
NPI:1609338755
Name:YASSINE, SHAWN BUSH (PA)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:BUSH
Last Name:YASSINE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:LYNN
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD # 310
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3910
Mailing Address - Fax:
Practice Address - Street 1:13640 N PLAZA DEL RIO BLVD # 310
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4846
Practice Address - Country:US
Practice Address - Phone:623-876-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ390200000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program