Provider Demographics
NPI:1972502987
Name:MCELROY, SHANNON G (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:G
Last Name:MCELROY
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 1:315 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-3815
Mailing Address - Country:US
Mailing Address - Phone:336-349-3220
Mailing Address - Fax:336-349-2725
Practice Address - Street 1:315 S MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-3815
Practice Address - Country:US
Practice Address - Phone:336-349-3220
Practice Address - Fax:336-349-2725
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC970010712OtherRAILROAD MEDICARE
NC2749303HMedicare PIN
NCS62871Medicare UPIN
NC2749303DMedicare PIN
NC2749303GMedicare PIN