MEDICARE: SHANNON DELONG 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	PA9101942	FL

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	:	1497752679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON DELONG PA-C

Provider Business Mailing Address
First Line	:	2000 FOWLER GROVE BLVD FL 3
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-5050
Country	:	US
Telephone Number	:	407-614-0528
Fax Number	:	407-614-0529

Provider Business Practice Location Address
First Line	:	2000 FOWLER GROVE BLVD FL 3
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-5050
Country	:	US
Telephone Number	:	407-614-0528
Fax Number	:	407-614-0529

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	06/08/2016

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Directions to “ SHANNON DELONG PA-C” Practice Location

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