Healthcare Provider Details

I. General information

NPI: 1437142213
Provider Name (Legal Business Name): SHANE C MORGAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WAKE ROBIN RD UNIT 5
LINCOLN RI
02865-4208
US

IV. Provider business mailing address

3 WAKE ROBIN RD UNIT 5
LINCOLN RI
02865-4208
US

V. Phone/Fax

Practice location:
  • Phone: 401-475-9140
  • Fax: 401-475-2808
Mailing address:
  • Phone: 401-475-9140
  • Fax: 401-475-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00266
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: