Ewalt, Shane Joseph

Ewalt, Shane Joseph is an individual health care provider with primary practice located at 525 S Chandler Village Dr , Chandler AZ 85226-5069. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Ewalt, Shane Joseph can be contacted via phone (480) 750-0303.

Contact Information

Primary practice address
525 S Chandler Village Dr Chandler AZ 85226-5069
Phone: (480) 750-0303
Fax: (480) 786-5202
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 6865 Arizona
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 6865 Arizona

Profile Details

NPI number 1679091920
LBN Legal business name Ewalt, Shane Joseph
Credentials PHYSICIAN ASSISTANT
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 7th, 2017
Last updated Jul 29th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679091920 NPPES
Arizona MEDICAID 326698

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