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General NPI Number Information
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NPI Number | 1285110015
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Entity Type | Individual
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Provider Name | SHANNON GAYNER PA
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Gender | Female
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 115 E BAY AVE
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-3109
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Country | US
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Telephone | 609-971-3300
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Fax | 609-597-4656
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Provider Business Mailing Address
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Address Line | 35 BEAVERSON BLVD STE 8C
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City | BRICK
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State | NJ
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Zip | 08723-7861
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Country | US
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Telephone | 732-262-4262
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Fax | 732-262-4317
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00475900
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License Number State | NJ
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