Provider Demographics
NPI:1588277958
Name:GAINES, SHANNON LEE (PA-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:GAINES
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1768
Mailing Address - Country:US
Mailing Address - Phone:207-406-7600
Mailing Address - Fax:207-618-5683
Practice Address - Street 1:1 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1768
Practice Address - Country:US
Practice Address - Phone:207-406-7600
Practice Address - Fax:207-618-5683
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant