Provider Demographics
NPI:1821271685
Name:WEBB, SHANNON LEIGH (MMS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEIGH
Last Name:WEBB
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 NANCY RIDGE DR STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2253
Mailing Address - Country:US
Mailing Address - Phone:858-900-2747
Mailing Address - Fax:858-750-2984
Practice Address - Street 1:6605 NANCY RIDGE DR STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2253
Practice Address - Country:US
Practice Address - Phone:858-900-2747
Practice Address - Fax:858-750-2984
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19346363AM0700X
CAPA19346363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19346OtherSTATE LICENSE
1057171OtherNCCPA CERTIFICATION
TXPA03551OtherSTATE LICENSE
CAPA19346OtherSTATE LICENSE