Provider Demographics
NPI:1942453139
Name:SHAVER, ROBIN MICHELLE (PA)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:MICHELLE
Last Name:SHAVER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158A EASTCLIFF DR SE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-3719
Mailing Address - Country:US
Mailing Address - Phone:704-433-7579
Mailing Address - Fax:
Practice Address - Street 1:1221 21ST AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-7402
Practice Address - Country:US
Practice Address - Phone:843-626-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL1343363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant