Provider Demographics
NPI:1366863953
Name:SHIBATA, STEPHANIE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:SHIBATA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 N GIBSON RD STE 311
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-1708
Mailing Address - Country:US
Mailing Address - Phone:702-776-8300
Mailing Address - Fax:702-776-8408
Practice Address - Street 1:825 N GIBSON RD STE 311
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-1708
Practice Address - Country:US
Practice Address - Phone:027-768-3007
Practice Address - Fax:702-776-8408
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant