Provider Demographics
NPI:1255804233
Name:LEMAY, SHANNON JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:JEAN
Last Name:LEMAY
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:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-0391
Mailing Address - Country:US
Mailing Address - Phone:503-814-1397
Mailing Address - Fax:503-814-1402
Practice Address - Street 1:875 OAK ST SE STE 1080
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3977
Practice Address - Country:US
Practice Address - Phone:503-814-1397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA190334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500758208Medicaid