Individual provider Active NPI

Shelly Ann Winslow, PA-C

  • Physician Assistant
  • Plymouth, MN
National Provider Identifier
1689776544
Registry record updated Jun 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13222 Issued in MN
Practice address
15700 37TH Ave N Ste 300
Plymouth, MN 55446-3661
Phone
(612) 871-1145
Fax
(612) 870-5491
NPI assigned
Sep 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13222 MN Primary

Addresses

Primary practice location

15700 37TH Ave N Ste 300
Plymouth, MN 55446-3661

Mailing address

2734 Huron St
Roseville, MN 55113-1842

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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

Enrollment IDStateProvider typePAC IDDetails
I20200325002672 MN Practitioner - Physician Assistant 7911335989 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1689776544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2734 HURON ST",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15700 37TH AVE N STE 300",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463661",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINSLOW",
        "first_name": "SHELLY",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-02",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.