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Individual

SHELLYANN WALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.-C

Contact information

Practice address
118 NORTHPORT AVE, BELFAST, ME 04915-6009
(207) 338-2500
(207) 505-4590
Mailing address
90 SOUTHSIDE AVE, SUITE 350, ASHEVILLE, NC 28801-4160

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
103723
NC
363A00000X
Physician Assistant
Primary
PA2003
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1235157488
NC
Enumeration date
07/17/2006
Last updated
01/30/2024
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