Provider Demographics
NPI:1821300534
Name:MISHELOF, STUART E (PA)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:E
Last Name:MISHELOF
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 INDEPENDENCE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0258
Mailing Address - Country:US
Mailing Address - Phone:530-899-2106
Mailing Address - Fax:530-899-0142
Practice Address - Street 1:100 INDEPENDENCE CIR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0258
Practice Address - Country:US
Practice Address - Phone:530-899-2106
Practice Address - Fax:530-899-0142
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19688363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical