Provider Demographics
NPI:1013935386
Name:EDWARDS, SHELBY S (PA-C)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:S
Last Name:EDWARDS
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 1:4949 HARLEM RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2500
Mailing Address - Country:US
Mailing Address - Phone:716-204-3251
Mailing Address - Fax:716-204-3269
Practice Address - Street 1:4949 HARLEM RD
Practice Address - Street 2:SUITE 203
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2500
Practice Address - Country:US
Practice Address - Phone:716-204-3251
Practice Address - Fax:716-204-3269
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15441363A00000X
NY006040363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS44602Medicare UPIN