Individual provider · Type 1 NPI
Shelby Maryann Moderow
Medical Physician Assistant · Hill Afb, UT
NPI number
1366164535
Active
Practice location
7321 Balmer St # 570
Hill Afb, UT 84056-5012
Mailing address
1425 5th St N
Fargo, ND 58102-2734
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | None listed |
Medical Physician Assistant: Definition to come...
4 other providers at this address
About NPI 1366164535
Shelby Maryann Moderow's National Provider Identifier is 1366164535, issued on Sep 14, 2022. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Hill Afb, UT. The record was last updated on Sep 21, 2026.