Provider Demographics
NPI:1255598793
Name:FISH, SHANNON MARJORIE (SHANNON FISH PA-C)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MARJORIE
Last Name:FISH
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Gender:F
Credentials:SHANNON FISH PA-C
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Mailing Address - Street 1:450 BROADWAY ST
Mailing Address - Street 2:PAVILION A, 1ST FLOOR
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-3132
Mailing Address - Country:US
Mailing Address - Phone:650-723-6238
Mailing Address - Fax:650-721-3417
Practice Address - Street 1:450 BROADWAY ST
Practice Address - Street 2:PAVILION A, 1ST FLOOR
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-3132
Practice Address - Country:US
Practice Address - Phone:650-723-6238
Practice Address - Fax:650-721-3417
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2012-08-03
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Provider Licenses
StateLicense IDTaxonomies
CAPA17422363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical