Healthcare Provider Details

I. General information

NPI: 1134469687
Provider Name (Legal Business Name): MEGAN E GANONG SHIRLEY PA-C, MPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 FABIAN WAY
TAHOE CITY CA
96145-2032
US

IV. Provider business mailing address

10956 DONNER PASS RD STE 230
TRUCKEE CA
96161-4862
US

V. Phone/Fax

Practice location:
  • Phone: 530-581-8864
  • Fax:
Mailing address:
  • Phone: 530-582-3277
  • Fax: 530-550-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number22841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: