Provider Demographics
NPI:1467131029
Name:CUMMINGS, SHANNON CELINE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CELINE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:CELINE
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 COMMERCE PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7386
Mailing Address - Country:US
Mailing Address - Phone:910-739-1666
Mailing Address - Fax:910-739-6822
Practice Address - Street 1:1309 E 5TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-6031
Practice Address - Country:US
Practice Address - Phone:910-739-1666
Practice Address - Fax:910-739-6822
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001013369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant