Provider Demographics
NPI:1962706341
Name:KIRBY, SHELLEY B (PA-C)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:B
Last Name:KIRBY
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 C ST STE 550
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3386
Practice Address - Country:US
Practice Address - Phone:916-733-2900
Practice Address - Fax:916-733-2996
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21394363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEK874ZOtherNORTHERN CALIFORNIA MEDICARE
CAEK874ZOtherSOUTHERN CALIFORNIA MEDICARE