Provider Demographics
NPI:1336126465
Name:WINSETT, SHANNON M (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:WINSETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:RUMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:775 NORMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042
Mailing Address - Country:US
Mailing Address - Phone:717-274-5500
Mailing Address - Fax:717-202-0130
Practice Address - Street 1:775 NORMAN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7497
Practice Address - Country:US
Practice Address - Phone:717-274-5500
Practice Address - Fax:717-202-0130
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051455363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA078720Medicare PIN
PAQ15056Medicare UPIN
PA502770FLTMedicare PIN