Shane Michael Mikolajewski, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

4175 S Alamo Ave
Davis Monthan Afb, AZ 85707-4402

Phone

(520) 228-2703

NPI assigned

Aug 31, 2021

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1962170399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4175 S ALAMO AVE",
            "city": "DAVIS MONTHAN AFB",
            "state": "AZ",
            "postal_code": "857074402",
            "telephone_number": "520-228-2703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4175 S ALAMO AVE",
            "city": "DAVIS MONTHAN AFB",
            "state": "AZ",
            "postal_code": "857074402",
            "telephone_number": "520-228-2703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKOLAJEWSKI",
        "first_name": "SHANE",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-31",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Cooper Lee Jr., DDS
• Robin L Livingston, DMD
• Payton Lofton, DMD
• Jacob Mack, DMD
• Annetta Rachelle Medaugh, R.N.
• Nicholas Miller, DDS
• Erin Moore, PA-C
• John Patrick Moran, M.D.
• Nationwide Optometry P.C.
• Katharine Lindsey Neff, DO

• Physician Assistant in Davis Monthan Afb, AZ
• Providers in Davis Monthan Afb, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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.