Provider Demographics
NPI:1497750061
Name:FITZPATRICK, SHAWNTA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SHAWNTA
Middle Name:
Last Name:FITZPATRICK
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 1:712 OGLETHORPE ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2735
Mailing Address - Country:US
Mailing Address - Phone:301-839-1600
Mailing Address - Fax:301-749-0027
Practice Address - Street 1:6144 OXON HILL RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3107
Practice Address - Country:US
Practice Address - Phone:301-839-1600
Practice Address - Fax:301-749-0027
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030272363A00000X
MDC0002574363A00000X
VA0110001741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant