Provider Demographics
NPI:1730569187
Name:EPSTEIN, SHELBY R (PA-C)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:R
Last Name:EPSTEIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:E
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4321 109TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6794
Mailing Address - Country:US
Mailing Address - Phone:763-726-9153
Mailing Address - Fax:877-409-1792
Practice Address - Street 1:4321 109TH AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-6794
Practice Address - Country:US
Practice Address - Phone:763-726-9153
Practice Address - Fax:877-409-1792
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11911363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant