Blake Reza Shahlaie, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

145511 Issued in AK

Practice address

185 Hoffman Road
Bethel, AK 55995

Phone

(907) 543-5158

NPI assigned

May 3, 2019

Last updated

Oct 7, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1556841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570406400000",
    "number": "1346805454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 194",
            "city": "BETHEL",
            "state": "AK",
            "postal_code": "995590194",
            "telephone_number": "907-543-6149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 HOFFMAN ROAD",
            "city": "BETHEL",
            "state": "AK",
            "postal_code": "55995",
            "telephone_number": "907-543-5158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHLAIE",
        "first_name": "BLAKE",
        "middle_name": "REZA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-03",
        "last_updated": "2019-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "145511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA DEPARTMENT OF HEALTH",
            "identifier": "9111989",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALASKA BOARD OF MEDICINE",
            "identifier": "145511",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "bshahlaie1206@yahoo.com",
            "affiliation": "N",
            "endpointDescription": "Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "185 Hoffman Road",
            "city": "Bethel",
            "state": "AK",
            "country_code": "US",
            "postal_code": "55995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Amanda Shavings, PDHA 1

• Physician Assistant in Bethel, AK
• Providers in Bethel, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.