Provider Demographics
NPI:1700951837
Name:TRAHAN, SHANNA Y (PAA)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:Y
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:PAA
Other - Prefix:MS
Other - First Name:SHANNA
Other - Middle Name:R
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAA
Mailing Address - Street 1:PO BOX 603484
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3484
Mailing Address - Country:US
Mailing Address - Phone:803-765-1838
Mailing Address - Fax:803-765-1732
Practice Address - Street 1:2095 HENRY TECKLENBURG DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5733
Practice Address - Country:US
Practice Address - Phone:843-402-1436
Practice Address - Fax:843-402-1833
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004391367H00000X
SC102367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant