Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Nicole Warner Shaha, PA-C

Individual provider Surgical Physician Assistant · NPI 1477078764

Mrs. Nicole Warner Shaha, PA-C is a Physician Assistant in Mesa, Arizona. Qualified in 2017, 9 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
9
Licensed in
AZ
In the registry since
2017
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

2545 E Intrepid Ave
Mesa, AZ 85204-7028
Phone: (208) 716-2350
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 6826 (AZ)

Record details

NPI number1477078764
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedAugust 7, 2017
Last updated in NPPESSeptember 17, 2024
Certification dateSeptember 17, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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