Provider Demographics
NPI:1194798413
Name:SHANNON, AMY K (DO)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:SHANNON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:K
Other - Last Name:LOWERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:230 FRAZIER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1566
Mailing Address - Country:US
Mailing Address - Phone:724-977-2703
Mailing Address - Fax:
Practice Address - Street 1:2009 MACKENZIE WAY STE 100
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-5338
Practice Address - Country:US
Practice Address - Phone:724-698-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012796207V00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94409Medicare UPIN
9342991Medicare ID - Type Unspecified
OH2447301Medicaid