Provider Demographics
NPI:1700842317
Name:BREHM, SHELLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:BREHM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 29130
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-692-1181
Mailing Address - Fax:210-692-7584
Practice Address - Street 1:9635 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-692-1181
Practice Address - Fax:210-692-7584
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04203363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
8C8172Medicare PIN
Q29323Medicare UPIN
TXQ29322Medicare UPIN
TX8C8172Medicare PIN