Healthcare Provider Details

I. General information

NPI: 1861016982
Provider Name (Legal Business Name): KATE SHANNAHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 NW 1ST AVE
GAINESVILLE FL
32607-2223
US

IV. Provider business mailing address

4551 NW 1ST AVE
GAINESVILLE FL
32607-2223
US

V. Phone/Fax

Practice location:
  • Phone: 443-786-1122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: