Provider Demographics
NPI:1245535533
Name:EVANGELISTA, REBECCA MARIE SHELTON (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA MARIE
Middle Name:SHELTON
Last Name:EVANGELISTA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2608 ERWIN RD
Mailing Address - Street 2:STE 200
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4596
Mailing Address - Country:US
Mailing Address - Phone:919-684-2595
Mailing Address - Fax:
Practice Address - Street 1:2608 ERWIN RD
Practice Address - Street 2:STE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4596
Practice Address - Country:US
Practice Address - Phone:919-684-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC001002526363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC001002526OtherSTATE LICENSE