Provider Demographics
NPI:1538724265
Name:SHANNON, PATRICIA ANN (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:SHANNON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 WALKER LN STE 507
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3251
Mailing Address - Country:US
Mailing Address - Phone:703-738-4332
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 205
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6797
Practice Address - Country:US
Practice Address - Phone:301-665-4950
Practice Address - Fax:301-665-4956
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC07394363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant