Individual
SHELLY ANN MINISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
610 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2372
(505) 242-3991
(505) 998-1660
Mailing address
610 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2372
(505) 242-3991
(505) 998-1660
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA2016-0106
NM
363AM0700X
Medical Physician Assistant
Primary
PA2016-0106
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2016-0106
NM MEDICAL LICENSE
NM
Enumeration date
11/20/2013
Last updated
03/07/2023
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