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

Shamoon Mian, PA-C

Individual provider Physician Assistant · NPI 1417763087

Shamoon Mian, PA-C is a Physician Assistant in Green Bay, Wisconsin. Qualified in 2025, 1 year ago. Practices with New Dermatology Group Ltd, a 23-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
1
Licensed in
WI
In the registry since
2024
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

3059 Voyager Dr
Green Bay, WI 54311-8303
Phone: (920) 965-0345
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 853023 (WI)

Record details

NPI number1417763087
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedDecember 9, 2024
Last updated in NPPESOctober 3, 2025
Certification dateOctober 3, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice New Dermatology Group Ltd — 23 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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