SHELLY ANN MINISH (NPI# 1477983849) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477983849 |
| Entity Type | Individual |
| Full Name | SHELLY ANN MINISH |
| Credential | PA-C |
| Practice Address |
610 Broadway Blvd Ne Albuquerque NM 87102-2372 |
| Practice Telephone | 5052423991 |
| Practice Fax Number | 5059981660 |
| Mailing Telephone | 5052423991 |
| Mailing Fax Number | 5059981660 |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2017-01-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | PA2016-0106 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA2016-0106 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA LICENSE | MM3069603 | 01 | |
| NM | NM MEDICAL LICENSE | PA2016-0106 | 01 |
| Street Address |
610 BROADWAY BLVD NE |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87102-2372 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174525257 | Damara Lee Kaplan | Urology | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2005-06-02 |
| 1104468438 | Dermatology of New Mexico LLC | Clinic/Center | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2019-10-08 |
| 1689063323 | Jaren P Gravagne | Registered Nurse | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2015-01-19 |
| 1932514056 | Linda Karen Lee | Nurse Practitioner | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2014-06-26 |
| 1366865560 | Deitra Gates | Clinical Nurse Specialist | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2014-01-24 |
| 1821424219 | Anna E Knackstedt | Physician Assistant | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2013-09-18 |
| 1811157100 | Andrew Grollman | Specialist | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2008-06-11 |
| 1134394430 | Peter Abraham Headley | Specialist | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2008-04-28 |
| 1508034588 | Jamie F Edens | Physician Assistant | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2008-02-13 |
| 1114123593 | Hannah Ruth Kerr | Transplant Surgery | 610 Broadway Blvd Ne, Albuquerque, NM 87102-2372 | 2007-06-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407454937 | Julie Wood | Acupuncturist | 1600 Luna Circle Nw, Albuquerque, NM 87102 | 2020-10-16 |
| 1770121410 | Emily Perez | Counselor | 218 Broadway Ne, Albuquerque, NM 87102 | 2019-12-12 |
| 1417503392 | Tess Holtry | Behavior Technician | 1424 Walter St Nw, Albuquerque, NM 87102 | 2019-08-15 |
| 1942867486 | Christy E Cheromiah | Behavioral Analyst | Open Skies Helathcare, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-05-21 |
| 1730744103 | Faith Petra Maxwell | Behavior Technician | 900 Arno St, Albuquerque, NM 87102 | 2019-05-01 |
| 1568923761 | Storm Swinford | Behavioral Analyst | Open Skies Healthcare, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-03-29 |
| 1093276651 | Tina Marie Trujillo | Behavioral Analyst | Open Skies Health Care, 707 Broadway Blvd Ne, Albuquerque, NM 87102 | 2019-03-27 |
| 1861950370 | Meghan Montoya | Student in an Organized Health Care Education/Training Program | 801 Camino De Salud, Albuquerque, NM 87102 | 2019-03-05 |
| 1174099329 | Dilshani N Tyson | Counselor | 600 1st Street Nw Ste 200, Albuquerque, NM 87102 | 2018-10-15 |
| 1962987925 | Tania L Goldfeder | Social Worker | New Mexico Solutions, 707 Broadway Ne Suite 500, Albuquerque, NM 87102 | 2018-09-26 |
| Find all providers in zip 87102 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386284602 | Christopher Whorley | Physician Assistant | 4683 Idlewilde Ln Se, Albuquerque, NM 87108-3421 | 2020-01-15 |
| 1053836809 | Alysha Gallegos | Physician Assistant | 6112 Molinero Ct Sw, Albuquerque, NM 87105-6814 | 2017-08-13 |
| 1306225180 | Allison Rose Crossey | Physician Assistant | 201 Cedar Street Se, Suite 6600, Albuquerque, NM 87106 | 2015-05-26 |
| 1336543115 | Pamela O Black Md, P.a., Dba Quadra Health Institute | Physician Assistant | 3820 Commons Ave Ne # M, Albuquerque, NM 87109-5831 | 2014-10-22 |
| 1457686511 | Bayle R. Curtis | Physician Assistant | 1806 Morningrise Pl Se, Albuquerque, NM 87108-4520 | 2009-10-07 |
| 1215173919 | Amber Dawn Hansen | Physician Assistant | 1100 Cenrral Ave Se, Albuquerque, NM 87106 | 2008-12-30 |
| 1508028606 | Angela Genette Baumeister | Physician Assistant | 707 13th St Nw, Albuquerque, NM 87102-1841 | 2008-06-30 |
| 1528230117 | Laura Wylie | Physician Assistant | 1101 Medical Arts Ave Ne # 4, Building 4, Suite A, Unm Senior Health, Albuquerque, NM 87102-2706 | 2008-03-24 |
| 1457406951 | Deneen Tomayko | Physician Assistant | 2211 Lomas Blvd Ne Fl 4, Albuquerque, NM 87106-2745 | 2007-01-24 |
| 1083793665 | Karen Kay Nester | Physician Assistant | 4901 Lang Ave, Ne, Suite 100, Albuquerque, NM 87109-4597 | 2006-11-03 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87102 |
Please comment or provide details below to improve the information on SHELLY ANN MINISH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.