Provider Demographics
NPI:1821326505
Name:SHUPETALLEY, EMILY E (PA-C)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:E
Last Name:SHUPETALLEY
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2975 ROSLYN ST UNIT 100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3326
Mailing Address - Country:US
Mailing Address - Phone:303-626-7944
Mailing Address - Fax:303-763-5495
Practice Address - Street 1:1258 S PEARL ST STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1538
Practice Address - Country:US
Practice Address - Phone:303-399-7970
Practice Address - Fax:303-399-7905
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2022-03-17
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Provider Licenses
StateLicense IDTaxonomies
COPA.0002524363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant