Provider Demographics
NPI:1750865200
Name:ALONGE, SHAWNA ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:ANN
Last Name:ALONGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SHAWNA
Other - Middle Name:ANN
Other - Last Name:RAYMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:84 BLISS ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-1614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 ALLEN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6968
Practice Address - Country:US
Practice Address - Phone:716-338-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022625363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant