Provider Demographics
NPI:1992582175
Name:STEVENSON, SHELBY MAY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:MAY
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:MAY
Other - Last Name:DEETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-333-5000
Mailing Address - Fax:814-373-2338
Practice Address - Street 1:16792 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3748
Practice Address - Country:US
Practice Address - Phone:814-373-2335
Practice Address - Fax:814-373-2338
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN719033163W00000X
PASP028298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse