Provider Demographics
NPI:1285110015
Name:MCALLISTER, SHANNON (PA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 COTTAGE PL APT 2
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-5790
Mailing Address - Country:US
Mailing Address - Phone:609-923-4704
Mailing Address - Fax:
Practice Address - Street 1:115 E BAY AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3109
Practice Address - Country:US
Practice Address - Phone:609-971-3300
Practice Address - Fax:609-597-4656
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00475900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical