Provider Demographics
NPI:1063870830
Name:FITCH, SHELBY ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:ANN
Last Name:FITCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:ANN
Other - Last Name:KNOPICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:315 STRUTHERS LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:OH
Mailing Address - Zip Code:44405-1973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 STRUTHERS LIBERTY RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:OH
Practice Address - Zip Code:44405-1973
Practice Address - Country:US
Practice Address - Phone:330-750-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058104363A00000X
OH50.004593RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant