MEDICARE: SHANNON SULLIVAN SMITHSON PA-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
2	363A00000X	Physician Assistant	21852	CA

General Provider Information

NPI Number	:	1154603264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON SULLIVAN SMITHSON PA-C

Provider Business Mailing Address
First Line	:	1513 FREMONT BLVD STE E1
Second Line	:
City	:	SEASIDE
State	:	CA
Zip	:	93955-4319
Country	:	US
Telephone Number	:	831-899-1910
Fax Number	:	831-393-9483

Provider Business Practice Location Address
First Line	:	1513 FREMONT BLVD STE E1
Second Line	:
City	:	SEASIDE
State	:	CA
Zip	:	93955-4319
Country	:	US
Telephone Number	:	831-899-1910
Fax Number	:	831-393-9483

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

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	04/30/2019

Similar Medicare Providers

1437142270 — ERIC S PARSONS MD
Practice Location Address:

1513 FREMONT BLVD # E1
SEASIDE, CA
93955-4319

Practice Phone: 831-899-1910
Practice Fax:

1568431617 — MARY K SWEET MD
Practice Location Address:

1513 FREMONT BLVD # E1
SEASIDE, CA
93955-4319

Practice Phone: 831-899-1910
Practice Fax: 831-393-9480

1376857771 — MS. AUDREY LEE WINGO
Practice Location Address:

1513 FREMONT BLVD # E-2
SEASIDE, CA
93955-4319

Practice Phone: 831-324-4492
Practice Fax:

1265872311 — SUMEET SINGH DDS
Practice Location Address:

1513 FREMONT BLVD , SUITE E-2
SEASIDE, CA
93955-4319

Practice Phone: 201-755-4755
Practice Fax:

1023450855 — SEASIDE DOCTORS ON DUTY
Practice Location Address:

1513 FREMONT BLVD , E1
SEASIDE, CA
93955-4319

Practice Phone: 831-899-1910
Practice Fax:

1336548536 — WAEL ALFY
Practice Location Address:

1513 FREMONT BLVD , SUITE E-2
SEASIDE, CA
93955-4319

Practice Phone: 831-324-4492
Practice Fax:

Directions to “ SHANNON SULLIVAN SMITHSON PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.