| NPI | 1770620601 |
|---|---|
| Other Name | STEPHANIE SHANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 008400) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 008400) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2012-07-25 |