Healthcare Provider Details

I. General information

NPI: 1295134187
Provider Name (Legal Business Name): SHANNON M NEWTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON KEOHANE PAC

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD COURT RD
RANDALLSTOWN MD
21133-5103
US

IV. Provider business mailing address

621 SHROPSHIRE DR
WEST CHESTER PA
19382-2231
US

V. Phone/Fax

Practice location:
  • Phone: 410-521-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA064232
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: