Provider Demographics
NPI:1982649695
Name:POLONE, SHANNON S (PA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:S
Last Name:POLONE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-793-5237
Mailing Address - Fax:325-793-5239
Practice Address - Street 1:6399 DIRECTORS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5876
Practice Address - Country:US
Practice Address - Phone:325-670-6457
Practice Address - Fax:325-670-6498
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP52039Medicare UPIN
TX8G7283Medicare PIN