Provider Demographics
NPI:1972924561
Name:DEAN, PRECIOUS SHENANDOAH (PA)
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:SHENANDOAH
Last Name:DEAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 MAINE ST
Mailing Address - Street 2:SUITE 23
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3358
Mailing Address - Country:US
Mailing Address - Phone:207-729-0134
Mailing Address - Fax:207-729-6626
Practice Address - Street 1:331 MAINE ST
Practice Address - Street 2:SUITE 23
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3358
Practice Address - Country:US
Practice Address - Phone:207-729-0134
Practice Address - Fax:207-729-6626
Is Sole Proprietor?:No
Enumeration Date:2013-12-27
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY017412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400191614Medicare PIN