Healthcare Provider Details

I. General information

NPI: 1194798413
Provider Name (Legal Business Name): AMY K SHANNON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY K LOWERY DO

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 MACKENZIE WAY STE 100
CRANBERRY TOWNSHIP PA
16066-5338
US

IV. Provider business mailing address

230 FRAZIER LAKE DR
NEW CASTLE PA
16105-1566
US

V. Phone/Fax

Practice location:
  • Phone: 724-698-7334
  • Fax:
Mailing address:
  • Phone: 724-977-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS012796
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number34.007656CTR
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS012796
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: