Provider Demographics
NPI:1114998069
Name:STATON, SHANNON L (PA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:STATON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6179 S BALSAM WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3091
Mailing Address - Country:US
Mailing Address - Phone:303-948-1570
Mailing Address - Fax:303-972-6871
Practice Address - Street 1:6179 S BALSAM WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3091
Practice Address - Country:US
Practice Address - Phone:303-948-1570
Practice Address - Fax:303-972-6871
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO2093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant