Provider Demographics
NPI:1952620676
Name:ELLIOTT-DEMARS, JOY SHALOMA (PA-C)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:SHALOMA
Last Name:ELLIOTT-DEMARS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:SHALOMA
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3619
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:4555 PRECISSI LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6239
Practice Address - Country:US
Practice Address - Phone:209-477-4103
Practice Address - Fax:209-477-1065
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22562363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant