Provider Demographics
NPI:1912876921
Name:CHILMAN, SHELBY TIANA TREVINO (PA-C)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:TIANA TREVINO
Last Name:CHILMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:TIANA
Other - Last Name:TREVINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:928 BRINTON RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:MI
Mailing Address - Zip Code:48893-7601
Mailing Address - Country:US
Mailing Address - Phone:989-506-4972
Mailing Address - Fax:
Practice Address - Street 1:4100 CAMPUS RIDGE DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6139
Practice Address - Country:US
Practice Address - Phone:989-839-1795
Practice Address - Fax:989-839-1785
Is Sole Proprietor?:No
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601013564363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant