Provider Demographics
NPI:1144912593
Name:MCCUE, SHANNA MAE (PA-C)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:MAE
Last Name:MCCUE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 EL CAMINO REAL STE 101
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94027-4110
Mailing Address - Country:US
Mailing Address - Phone:650-325-1395
Mailing Address - Fax:
Practice Address - Street 1:1706 EL CAMINO REAL STE 101
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94027-4110
Practice Address - Country:US
Practice Address - Phone:650-325-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA64623363A00000X
MAPA9470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110199973AMedicaid