Provider Demographics
NPI:1629021522
Name:SHUMILOFF, SHALEE LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHALEE
Middle Name:LYNN
Last Name:SHUMILOFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHALEE
Other - Middle Name:LYNN
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 RIDGEVIEW DR
Mailing Address - Street 2:UNIT 3
Mailing Address - City:SMITHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15478-1650
Mailing Address - Country:US
Mailing Address - Phone:724-569-8100
Mailing Address - Fax:724-569-8100
Practice Address - Street 1:100 RIDGEVIEW DR
Practice Address - Street 2:UNIT 3
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-1650
Practice Address - Country:US
Practice Address - Phone:724-569-8100
Practice Address - Fax:724-569-8100
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051854363AM0700X, 363A00000X
TN1399363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA382097YP91OtherPTAN
PAQ39694Medicare UPIN