Shane Udelhoven, PA-C
Physician Assistant, Medical in Soldotna, AK. Individual provider (NPI-1).
NPI number1124355359
StatusActive
Last updated in NPPESFeb 18, 2020
Details
- NPI
- 1124355359
- Entity type
- Individual (NPI-1)
- Name
- Shane Udelhoven
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 9, 2009
- Certification date
- Feb 18, 2020
- Last updated
- Feb 18, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | PADA893 | AK | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
35670 Kenai Spur Hwy Ste 103aSoldotna, AK 99669-7649
Phone 907-260-1655 · Fax 980-495-8870
Mailing address
48690 Tote RdSoldotna, AK 99669-9155
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Medical Physician Assistant providers in Soldotna, AK
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- Daniel D Nyitrai, PA-CNPI 1962494781
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- Bryan Lee Pherson, PA-CNPI 1619162799
All 5 Medical Physician Assistant providers in Soldotna · All 1,110 providers in Soldotna
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