| NPI | 1972834240 |
|---|---|
| Former Name | SHANNON KATHLEEN MALLORY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004255RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.004255) |
| Enumeration Date | 2010-01-26 |
| Last Update Date | 2024-09-16 |