Provider Demographics
NPI:1861453185
Name:O'BRIEN, SHELLEY JANE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:JANE
Last Name:O'BRIEN
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 1:714 MILL ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-2264
Mailing Address - Country:US
Mailing Address - Phone:248-684-5687
Mailing Address - Fax:
Practice Address - Street 1:5301 EAST HURON RIVER DRIVE
Practice Address - Street 2:ST. JOSEPH MERCY HOSPITAL
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48106
Practice Address - Country:US
Practice Address - Phone:734-712-2683
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002839363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical