Provider Demographics
NPI:1053644658
Name:MCCORMICK, SHANNON ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROSE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:ROSE
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 LINCOLN STREET
Mailing Address - Street 2:METROWEST MEDICAL CENTER EMERGENCY DEPARTMENT
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6358
Mailing Address - Country:US
Mailing Address - Phone:978-807-2262
Mailing Address - Fax:
Practice Address - Street 1:115 LINCOLN STREET
Practice Address - Street 2:METROWEST MEDICAL CENTER EMERGENCY DEPARTMENT
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6358
Practice Address - Country:US
Practice Address - Phone:978-807-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MAPA3869363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant