Provider Demographics
NPI:1538304381
Name:SHURILLA, KATY (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KATY
Middle Name:
Last Name:SHURILLA
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 1:1305 BOARDMAN POLAND RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1935
Mailing Address - Country:US
Mailing Address - Phone:330-629-2300
Mailing Address - Fax:
Practice Address - Street 1:1305 BOARDMAN POLAND RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1935
Practice Address - Country:US
Practice Address - Phone:330-629-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002857363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0083980Medicaid
OH0083980Medicaid