Provider Demographics
NPI:1417350976
Name:FARRELL, SHANNON LENORE (PA)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LENORE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:DEPARTMENT OF NEUROLOGICAL SURGERY UCSF
Mailing Address - Street 2:400 PARNASSUS AVENUE, ROOM A311
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF NEUROLOGICAL SURGERY UCSF
Practice Address - Street 2:400 PARNASSUS AVENUE, ROOM A311
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0332
Practice Address - Country:US
Practice Address - Phone:415-353-9369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA51837363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical