Provider Demographics
NPI:1033817804
Name:BEATY, SHELLEY MONIQUE (PA-C)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MONIQUE
Last Name:BEATY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:BEATY
Other - Last Name:HARRELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2508 PELHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2508 PELHAM PKWY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1321
Practice Address - Country:US
Practice Address - Phone:205-664-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2149363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant