Provider Demographics
NPI:1427776715
Name:RICH, EMILY SHELLEY (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:SHELLEY
Last Name:RICH
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 1:17638 DEER ISLE CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9454
Mailing Address - Country:US
Mailing Address - Phone:407-748-7574
Mailing Address - Fax:
Practice Address - Street 1:17638 DEER ISLE CIR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9454
Practice Address - Country:US
Practice Address - Phone:407-748-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant