Provider Demographics
NPI:1437667441
Name:CHESTER, SHANNON MARY (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARY
Last Name:CHESTER
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3400 SPRUCE STREET
Mailing Address - Street 2:GROUND SILVERSTEIN BLDG
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-6698
Mailing Address - Fax:215-662-3953
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:GROUND SILVERSTEIN BLDG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-662-6698
Practice Address - Fax:215-662-3953
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA059683363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical