Provider Demographics
NPI:1447503412
Name:DEL GRANDE, SHANNON LEA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEA
Last Name:DEL GRANDE
Suffix:
Gender:F
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 1:775 E LANCASTER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1529
Mailing Address - Country:US
Mailing Address - Phone:610-525-7800
Mailing Address - Fax:610-525-7801
Practice Address - Street 1:775 E LANCASTER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1529
Practice Address - Country:US
Practice Address - Phone:610-525-7800
Practice Address - Fax:610-525-7801
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000845363AS0400X
PAMA057827363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical