Provider Demographics
NPI:1497304778
Name:BATT, SHANNON PAIGE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:PAIGE
Last Name:BATT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4111
Mailing Address - Country:US
Mailing Address - Phone:516-459-6570
Mailing Address - Fax:
Practice Address - Street 1:153 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4111
Practice Address - Country:US
Practice Address - Phone:516-459-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023961363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant