Provider Demographics
NPI:1134401326
Name:GABIOLA SHELTON, A TERESA (PA)
Entity type:Individual
Prefix:
First Name:A TERESA
Middle Name:
Last Name:GABIOLA SHELTON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3340 E GOLDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-8550
Mailing Address - Fax:208-367-8555
Practice Address - Street 1:6051 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8969
Practice Address - Country:US
Practice Address - Phone:208-302-5150
Practice Address - Fax:208-302-5155
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2022-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT8075898-1206363AM0700X
IDPA-1091363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical