Provider Demographics
NPI:1356665509
Name:ZUNDEL, SHANNON DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DAWN
Last Name:ZUNDEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:DAWN
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:322 ESTATES VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-6013
Mailing Address - Country:US
Mailing Address - Phone:215-222-1218
Mailing Address - Fax:
Practice Address - Street 1:185 PROFESSIONAL COURT
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701
Practice Address - Country:US
Practice Address - Phone:706-383-3189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005735363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003141153HMedicaid
GA003141153DMedicaid
GA003141153GMedicaid
GA003141153EMedicaid
GA003141153FMedicaid
GA003141153GMedicaid