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General NPI Number Information
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NPI Number | 1740568062
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Entity Type | Individual
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Provider Name | SHANNON DIEHL PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1200 STATE ROUTE 208 STE 15
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City | MONROE
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State | NY
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Zip | 10950-4649
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Country | US
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Telephone | 845-549-1010
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Fax | 845-565-5027
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Provider Business Mailing Address
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Address Line | 2 COATES DR
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City | GOSHEN
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State | NY
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Zip | 10924-6758
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Country | US
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Telephone | 845-651-1400
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Fax | 845-651-1512
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 014968
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License Number State | NY
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