MEDICARE: SHANNON K HAMMOND 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	1659	OH

General Provider Information

NPI Number	:	1154506483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON K HAMMOND PA-C

Provider Business Mailing Address
First Line	:	1417 RIDGE CROSS RD
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-8965
Country	:	US
Telephone Number	:	419-874-5464
Fax Number	:	419-872-2369

Provider Business Practice Location Address
First Line	:	12780 ROACHTON RD # 1
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-1350
Country	:	US
Telephone Number	:	419-872-0777
Fax Number	:	419-872-2369

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

Provider Enumeration Date	:	01/05/2008
Last Update Date	:	10/14/2010

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