Provider Demographics
NPI:1649741968
Name:STINSON, SHELBY KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:KAY
Last Name:STINSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50452
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-0452
Mailing Address - Country:US
Mailing Address - Phone:772-631-3181
Mailing Address - Fax:
Practice Address - Street 1:9900 TALBERT AVE STE 202
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:714-378-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-14
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant