Provider Demographics
NPI:1710920186
Name:MCMEEKIN-HAGADORN, SHANNON A (RPAC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:A
Last Name:MCMEEKIN-HAGADORN
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 MARGARET ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1874
Mailing Address - Country:US
Mailing Address - Phone:518-561-3377
Mailing Address - Fax:518-563-7433
Practice Address - Street 1:159 MARGARET ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1874
Practice Address - Country:US
Practice Address - Phone:518-561-3377
Practice Address - Fax:518-563-7433
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008398363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000A99768003OtherBLUE SHIELD NENY
P56983Medicare UPIN