Provider Demographics
NPI:1326678426
Name:SMILEY, SHANNON (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SMILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:600 WESTAGE BUSINESS CTR DR
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2281
Mailing Address - Country:US
Mailing Address - Phone:845-231-5600
Mailing Address - Fax:845-231-5679
Practice Address - Street 1:600 WESTAGE BUSINESS CTR DR
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2281
Practice Address - Country:US
Practice Address - Phone:845-231-5600
Practice Address - Fax:845-231-5679
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA061358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant