Individual
SHYLA L RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
242 BRUNSWICK ST, OLD TOWN, ME 04468-1613
(207) 827-6128
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
(207) 992-9200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2724
ME
Other
Enumeration date
06/25/2024
Last updated
08/12/2024
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