Provider Demographics
NPI:1770840233
Name:SHEVLIN, SALLY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:SHEVLIN
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 1:725 GLENWOOD DR STE 488
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1173
Mailing Address - Country:US
Mailing Address - Phone:423-697-0621
Mailing Address - Fax:423-622-8716
Practice Address - Street 1:2290 OGLETREE AVE STE 102
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8828
Practice Address - Country:US
Practice Address - Phone:423-643-3772
Practice Address - Fax:423-643-3773
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1722363A00000X
TN2219363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1533128Medicaid
TN1533128Medicaid