Provider Demographics
NPI:1710146675
Name:KLEIN, SHELLY RAE (PA C)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:RAE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:MRS
Other - First Name:SHELLY
Other - Middle Name:RAE
Other - Last Name:ULFIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-4700
Mailing Address - Fax:989-583-7173
Practice Address - Street 1:900 COOPER AVE
Practice Address - Street 2:SUITE 4100
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5182
Practice Address - Country:US
Practice Address - Phone:989-583-4700
Practice Address - Fax:989-583-7173
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005250363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical