Provider Demographics
NPI:1780345124
Name:SHOLTY, DEVIN N (PA-C)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:N
Last Name:SHOLTY
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 1:975 BENNETT RD APT 21-204
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6200
Mailing Address - Country:US
Mailing Address - Phone:850-529-0446
Mailing Address - Fax:
Practice Address - Street 1:1910 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5528
Practice Address - Country:US
Practice Address - Phone:407-898-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115515363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant