Provider Demographics
NPI:1912358508
Name:FAWCETT, SHAYLA (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11216 SUNRISE BLVD E STE 3-207
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-8848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11216 SUNRISE BLVD E STE 3-207
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8848
Practice Address - Country:US
Practice Address - Phone:253-773-7002
Practice Address - Fax:253-435-7019
Is Sole Proprietor?:No
Enumeration Date:2016-06-25
Last Update Date:2019-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA60650435363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant