Provider Demographics
NPI:1669742797
Name:MALABUYO, SHANNON NEVAH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:NEVAH
Last Name:MALABUYO
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:221 E HACIENDA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-6625
Mailing Address - Country:US
Mailing Address - Phone:408-656-0234
Mailing Address - Fax:
Practice Address - Street 1:221 E HACIENDA AVE STE B
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6625
Practice Address - Country:US
Practice Address - Phone:408-376-3350
Practice Address - Fax:408-376-3350
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2017-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21972363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant