Healthcare Provider Details

I. General information

NPI: 1891979449
Provider Name (Legal Business Name): SHANNON ERIN BAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9582 PRINCETON GLENDALE RD
HAMILTON OH
45011-9778
US

IV. Provider business mailing address

9582 PRINCETON GLENDALE RD
HAMILTON OH
45011-9778
US

V. Phone/Fax

Practice location:
  • Phone: 513-346-5640
  • Fax: 513-346-5644
Mailing address:
  • Phone: 513-346-5640
  • Fax: 513-346-5644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1834
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: