Provider Demographics
NPI:1336798503
Name:KAMINSKY, SHELBY HANNAH (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:HANNAH
Last Name:KAMINSKY
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 1:1609 PASADENA AVE S STE 3M
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4563
Mailing Address - Country:US
Mailing Address - Phone:727-289-7137
Mailing Address - Fax:
Practice Address - Street 1:1609 PASADENA AVE S STE 3M
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4563
Practice Address - Country:US
Practice Address - Phone:727-289-7137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112443363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1165482OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
FL9112443OtherFLORIDA DEPARTMENT OF HEALTH