MEDICARE: SHANNON RILEY MULROONY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1013867639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON RILEY MULROONY PA-C

Provider Business Mailing Address
First Line	:	822 ROUTE 82 STE 320
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-7374
Country	:	US
Telephone Number	:	845-520-9904
Fax Number	:	845-579-2477

Provider Business Practice Location Address
First Line	:	822 ROUTE 82 STE 320
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-7374
Country	:	US
Telephone Number	:	845-520-9904
Fax Number	:	845-579-2477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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