Provider Demographics
NPI:1851693535
Name:DRAKE, SHEA ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHEA
Middle Name:ELIZABETH
Last Name:DRAKE
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 1:810 FRANCESCA WAY
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2589
Mailing Address - Country:US
Mailing Address - Phone:315-243-6891
Mailing Address - Fax:
Practice Address - Street 1:1065 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2952
Practice Address - Country:US
Practice Address - Phone:585-872-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006062363A00000X
NY014490363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant