Provider Demographics
NPI:1811032907
Name:FERRARI, SHANNON ROSE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ROSE
Last Name:FERRARI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:632 ARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1002
Mailing Address - Country:US
Mailing Address - Phone:412-831-1498
Mailing Address - Fax:412-641-5410
Practice Address - Street 1:300 HALKET ST
Practice Address - Street 2:SUITE 0610
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3108
Practice Address - Country:US
Practice Address - Phone:412-641-5411
Practice Address - Fax:412-641-5410
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA002759L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS72233Medicare UPIN