Provider Demographics
NPI:1871124065
Name:BAIRD, SHANNON ROISIN (PA-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROISIN
Last Name:BAIRD
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 1:9823 JAGGAR WAY
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-6456
Mailing Address - Country:US
Mailing Address - Phone:845-519-9105
Mailing Address - Fax:
Practice Address - Street 1:9823 JAGGAR WAY
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-6456
Practice Address - Country:US
Practice Address - Phone:845-519-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant