Provider Demographics
NPI:1699968008
Name:SHELBURNE, CHRISTOPHER T (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:T
Last Name:SHELBURNE
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4950 NORTON HEALTHCARE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2845
Practice Address - Country:US
Practice Address - Phone:502-583-1697
Practice Address - Fax:502-583-2120
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2018-12-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50032045OtherPASSPORT- NNIKY
KY122151OtherSIHO- NNIKY
KYP00948789OtherRAILROAD MEDICARE
KY7100155340Medicaid
KY000000690096OtherANTHEM- NNIKY
KY50032045OtherPASSPORT- NNIKY