Provider Demographics
NPI:1659772200
Name:SYNORACKI, SHANNON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:SYNORACKI
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 1:44095 PIPELINE PLZ
Mailing Address - Street 2:SUITE 430
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5898
Mailing Address - Country:US
Mailing Address - Phone:703-858-3208
Mailing Address - Fax:571-291-2289
Practice Address - Street 1:44095 PIPELINE PLZ
Practice Address - Street 2:SUITE 430
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5898
Practice Address - Country:US
Practice Address - Phone:703-858-3208
Practice Address - Fax:571-291-2289
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-004733363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical