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NPI Code Detail

MEDICARE: SHANNON DIEHL PA-C

MEDICARE: SHANNON DIEHL 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
1363A00000XPhysician Assistant014968NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1014968OTHERNYLICENSE

General Provider Information

NPI Number : 1740568062
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON DIEHL PA-C
Provider Business Mailing Address
First Line : 2 COATES DR
Second Line :
City : GOSHEN
State : NY
Zip : 10924-6758
Country : US
Telephone Number : 845-651-1400
Fax Number : 845-651-1512
Provider Business Practice Location Address
First Line : 1200 STATE ROUTE 208 STE 15
Second Line :
City : MONROE
State : NY
Zip : 10950-4649
Country : US
Telephone Number : 845-549-1010
Fax Number : 845-565-5027
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2011
Last Update Date : 10/31/2024

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Directions to “ SHANNON DIEHL PA-C” Practice Location

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