Healthcare Provider Details

I. General information

NPI: 1578868329
Provider Name (Legal Business Name): SHANNON DUGAN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E ROMIE LN
SALINAS CA
93901-4029
US

IV. Provider business mailing address

PO BOX 2420
SALINAS CA
93902-2420
US

V. Phone/Fax

Practice location:
  • Phone: 831-759-1840
  • Fax:
Mailing address:
  • Phone: 831-649-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2140
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number006044
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: