Provider Demographics
NPI:1659315448
Name:SHELLITO, ROBIN R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:R
Last Name:SHELLITO
Suffix:
Gender:M
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 1:305 JONES AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-1510
Mailing Address - Country:US
Mailing Address - Phone:706-554-5147
Mailing Address - Fax:706-554-6111
Practice Address - Street 1:810 CEMETERY ROAD
Practice Address - Street 2:MEDICAL ASSOCIATES OF SARDIS
Practice Address - City:SARDIS
Practice Address - State:GA
Practice Address - Zip Code:30456
Practice Address - Country:US
Practice Address - Phone:478-569-9600
Practice Address - Fax:478-569-4999
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002761363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97BBDVCMedicare ID - Type Unspecified
GAS20214Medicare UPIN