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 1:33 BEAVER DR
Mailing Address - Street 2:STE 1
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2434
Mailing Address - Country:US
Mailing Address - Phone:814-503-8070
Mailing Address - Fax:814-503-8531
Practice Address - Street 1:33 BEAVER DR
Practice Address - Street 2:STE 1
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2434
Practice Address - Country:US
Practice Address - Phone:814-503-8070
Practice Address - Fax:814-503-8531
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012796208D00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94409Medicare UPIN
9342991Medicare ID - Type Unspecified
OH2447301Medicaid