MEDICARE: MRS. SHANNA M EARLEY P.A.-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	01470	WV
2	363A00000X	Physician Assistant	50.002614RX	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053365262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNA M EARLEY P.A.-C

Provider Business Mailing Address
First Line	:	91 HORNER ST
Second Line	:
City	:	WEIRTON
State	:	WV
Zip	:	26062-6306
Country	:	US
Telephone Number	:	304-224-1216
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 W 5TH ST
Second Line	:	EMERGENCY DEPT
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-2405
Country	:	US
Telephone Number	:	330-386-2010
Fax Number	:	330-386-2061

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	11/02/2016

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Directions to “ MRS. SHANNA M EARLEY P.A.-C” Practice Location

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