Provider Demographics
NPI:1679032262
Name:DE RENOUARD, SHA'QUAYLA JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHA'QUAYLA
Middle Name:JEAN
Last Name:DE RENOUARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHA'QUAYLA
Other - Middle Name:JEAN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4815 LIBERTY AVE STE 425
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-359-4352
Mailing Address - Fax:
Practice Address - Street 1:4815 LIBERTY AVE STE 425
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-359-4352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060373363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
15058650OtherCAQH