Provider Demographics
NPI:1598157422
Name:DORAN, SHANNON M (PA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:DORAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:400 BALD HILL RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1617
Mailing Address - Country:US
Mailing Address - Phone:401-793-8520
Mailing Address - Fax:401-793-8527
Practice Address - Street 1:400 BALD HILL RD
Practice Address - Street 2:SUITE 520
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1617
Practice Address - Country:US
Practice Address - Phone:401-793-8520
Practice Address - Fax:401-793-8527
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2017-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIPA00796363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical