Michelle Dibaise, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

3633 Issued in AZ

Practice address

230 S 12TH Ave
Healthcare for the Homeless
Phoenix, AZ 85007-3101

Phone

(602) 827-2420

Fax

(602) 827-2425

NPI assigned

Jul 22, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Michelle Shumway Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1437523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437523200000",
    "number": "1568847267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 N 3RD ST # STREET-2",
            "address_2": "SHOW CLINIC #510 BB",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850042154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 S 12TH AVE",
            "address_2": "HEALTHCARE FOR THE HOMELESS",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850073101",
            "telephone_number": "602-827-2420",
            "fax_number": "602-827-2425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIBAISE",
        "first_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-22",
        "last_updated": "2015-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "3633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "SHUMWAY",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Pedro Diaz
• Robert Miguel Diaz, DPT
• Rolando Diaz, CRNA
• Juan Carlos Diazcadena, MD
• John Philip Dibacco, PHD
• Lindsay Hill Dibb, M.D.
• Derek Dibben, DNP, CRNA
• Melissa Dibble
• Linda A Diblasi, ARNP
• Haley N Dible, PA

• Medical Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2015; 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.