Provider Demographics
NPI:1558782623
Name:JABS, SHANNON AUSTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:AUSTIN
Last Name:JABS
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 1:1716 E HUNDRED RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-3301
Mailing Address - Country:US
Mailing Address - Phone:804-681-0177
Mailing Address - Fax:804-681-0747
Practice Address - Street 1:1716 E HUNDRED RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-3301
Practice Address - Country:US
Practice Address - Phone:804-681-0177
Practice Address - Fax:804-681-0747
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004416363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical