Provider Demographics
NPI:1548788193
Name:FERRARI, SHANNAN RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNAN
Middle Name:RAE
Last Name:FERRARI
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 1:1025 MAXWELL LN
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6823
Mailing Address - Country:US
Mailing Address - Phone:551-239-1770
Mailing Address - Fax:
Practice Address - Street 1:1025 MAXWELL LN
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6823
Practice Address - Country:US
Practice Address - Phone:551-239-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0212432086S0102X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care