MEDICARE: AMY K SHANNON DO

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	208D00000X	General Practice Physician	OS012796	PA
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	34.007656CTR	OH
3	207V00000X	Obstetrics & Gynecology Physician	OS012796	PA

General Provider Information

NPI Number	:	1194798413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY K SHANNON DO

Provider Business Mailing Address
First Line	:	230 FRAZIER LAKE DR
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16105-1566
Country	:	US
Telephone Number	:	724-977-2703
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 MACKENZIE WAY STE 100
Second Line	:
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-5338
Country	:	US
Telephone Number	:	724-698-7334
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	05/12/2026

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