Provider Demographics
NPI:1912503715
Name:RUBENSTEIN, SHELBY JADE (PA-C)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:JADE
Last Name:RUBENSTEIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:JADE
Other - Last Name:GRAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:33 E 33RD ST FL 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5362
Mailing Address - Country:US
Mailing Address - Phone:929-501-0535
Mailing Address - Fax:
Practice Address - Street 1:501 GORDON DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1252
Practice Address - Country:US
Practice Address - Phone:844-337-6362
Practice Address - Fax:646-665-3604
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062239363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant