Provider Demographics
NPI:1104143700
Name:VALIYAPARAMBIL, SHINEY (PA-C)
Entity type:Individual
Prefix:
First Name:SHINEY
Middle Name:
Last Name:VALIYAPARAMBIL
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 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7201
Mailing Address - Country:US
Mailing Address - Phone:214-645-4407
Mailing Address - Fax:
Practice Address - Street 1:UTSOUTHWESTERN
Practice Address - Street 2:5323 HARRY HINES BLVD
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9073
Practice Address - Country:US
Practice Address - Phone:214-645-4407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005888363A00000X
TXPA09144363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant