Shelby Wilson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5768 Issued in AZ

Practice address

18205 N 51St Ave
Suite 129
Glendale, AZ 85308-1490

Phone

(623) 398-8554

Fax

(623) 398-8278

NPI assigned

Aug 5, 2014

Last updated

Aug 5, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Arizona Center for Hematology and Oncology PLC

  • Hematology & Oncology Physician
  • Scottsdale, AZ
  • NPI 1841243722
  Medicare reassignment
• Arizona Center for Hematology and Oncology, PLC

  • Surgery Physician
  • Peoria, AZ
  • NPI 1083007165
  NPD
• Arizona Center for Hematology and Oncology, PLC

  • Urology Physician
  • Glendale, AZ
  • NPI 1548507510
  NPD
• Scottsdale Internal Medicine PLLC

  • Adult Health Clinical Nurse Specialist
  • Phoenix, AZ
  • NPI 1790050409
  NPD (past)
• Vitality Internal Medicine - Glendale LLC

  dba Mens Vitality Center

  • Primary Care Clinic/Center
  • Glendale, AZ
  • NPI 1336436690
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407196800000",
    "number": "1114336120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18205 N 51ST AVE",
            "address_2": "SUITE 129",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081490",
            "telephone_number": "623-398-8554",
            "fax_number": "623-398-8278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18205 N 51ST AVE",
            "address_2": "SUITE 129",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081490",
            "telephone_number": "623-398-8554",
            "fax_number": "623-398-8278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SHELBY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-05",
        "last_updated": "2014-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Wilson, P.T.
• Kristina Wilson, DMD
• Lori Anne Wilson, PSY.D., PSYCHOLOGIST
• Marylyn E Wilson, PHARM D
• Nakiya Wilson
• Mariah Wind
• Lizy Windsor, DNP, PMHNP-BC
• Robert S. Winkler, D.D.S.
• Mark Winograd, MD
• Damon Jonathan Winter

• Physician Assistant in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.