Provider Demographics
NPI:1912475708
Name:WENDT, SHANNON (PA-C, MHS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WENDT
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Gender:F
Credentials:PA-C, MHS
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Mailing Address - Street 1:244 MEDSPRING DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-9293
Mailing Address - Country:US
Mailing Address - Phone:919-359-0291
Mailing Address - Fax:919-553-2907
Practice Address - Street 1:244 MEDSPRING DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-9293
Practice Address - Country:US
Practice Address - Phone:919-359-0291
Practice Address - Fax:919-553-2907
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2021-03-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant