Provider Demographics
NPI:1508416884
Name:SHAWGO, LAUREN ISABEL (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ISABEL
Last Name:SHAWGO
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 1:1197 E HOOKSTOWN GRADE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:PA
Mailing Address - Zip Code:15026-1155
Mailing Address - Country:US
Mailing Address - Phone:724-480-6285
Mailing Address - Fax:
Practice Address - Street 1:7629 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6075
Practice Address - Country:US
Practice Address - Phone:330-965-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060805363AM0700X
OH50.006986RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical