Provider Demographics
NPI:1528835790
Name:SHAVERS, ASHLYN REBEKAH (PA)
Entity type:Individual
Prefix:
First Name:ASHLYN
Middle Name:REBEKAH
Last Name:SHAVERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ASHLYN
Other - Middle Name:
Other - Last Name:GEBBIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 LAUREL HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2423
Mailing Address - Country:US
Mailing Address - Phone:865-253-4963
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6440363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical