Provider Demographics
NPI:1275574121
Name:PENLAND, SHANNON KRISTEN (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:KRISTEN
Last Name:PENLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FAIRFIELD DRIVE
Mailing Address - Street 2:UPMC HILLMAN CANCER CENTER NORTHWEST
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346
Mailing Address - Country:US
Mailing Address - Phone:814-676-7900
Mailing Address - Fax:814-676-7887
Practice Address - Street 1:100 FAIRFIELD DRIVE
Practice Address - Street 2:UPMC HILLMAN CANCER CENTER NORTHWEST
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346
Practice Address - Country:US
Practice Address - Phone:814-676-7900
Practice Address - Fax:814-676-7887
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20207207RH0003X
PAMD464288207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02622390Medicaid
MS02622390Medicaid
MS512I830007Medicare PIN