MEDICARE: SHANNON AUSTIN JABS 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	363AM0700X	Medical Physician Assistant	0110004416	VA

General Provider Information

NPI Number	:	1558782623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON AUSTIN JABS PA-C

Provider Business Mailing Address
First Line	:	1716 E HUNDRED RD
Second Line	:	SUITE 102
City	:	CHESTER
State	:	VA
Zip	:	23836-3301
Country	:	US
Telephone Number	:	804-681-0177
Fax Number	:	804-681-0747

Provider Business Practice Location Address
First Line	:	1716 E HUNDRED RD
Second Line	:	SUITE 102
City	:	CHESTER
State	:	VA
Zip	:	23836-3301
Country	:	US
Telephone Number	:	804-681-0177
Fax Number	:	804-681-0747

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

Provider Enumeration Date	:	12/17/2013
Last Update Date	:	12/17/2013

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