Provider Demographics
NPI:1063176881
Name:NEU, SHYANNA ANNESS (PA-C)
Entity type:Individual
Prefix:
First Name:SHYANNA
Middle Name:ANNESS
Last Name:NEU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1315 FORTINO BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1981
Mailing Address - Country:US
Mailing Address - Phone:719-544-2744
Mailing Address - Fax:844-273-9854
Practice Address - Street 1:1315 FORTINO BLVD STE C
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1981
Practice Address - Country:US
Practice Address - Phone:719-544-2744
Practice Address - Fax:844-273-9854
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA.0007030363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant