Provider Demographics
NPI:1376179895
Name:BOX, SHANNEN ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:SHANNEN
Middle Name:ELIZABETH
Last Name:BOX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:289 PLEASANT ST STE 403
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3005
Mailing Address - Country:US
Mailing Address - Phone:508-675-5999
Mailing Address - Fax:
Practice Address - Street 1:289 PLEASANT ST STE 403
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3005
Practice Address - Country:US
Practice Address - Phone:508-675-5999
Practice Address - Fax:508-646-4334
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPA8904363A00000X
NY024871363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant