Provider Demographics
NPI:1881223022
Name:KASIK, SHELLY J (PA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:J
Last Name:KASIK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1629 CLOVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8109
Mailing Address - Country:US
Mailing Address - Phone:810-531-7328
Mailing Address - Fax:
Practice Address - Street 1:1554 WESLEY WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-687-6386
Practice Address - Fax:740-687-1388
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006413RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant