Provider Demographics
NPI:1871879270
Name:QUINN, SHANNON COLLEEN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:COLLEEN
Last Name:QUINN
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 1:6200 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7624
Mailing Address - Country:US
Mailing Address - Phone:330-966-8602
Mailing Address - Fax:330-966-8999
Practice Address - Street 1:6200 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7624
Practice Address - Country:US
Practice Address - Phone:330-966-8602
Practice Address - Fax:330-966-8999
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-29
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH012-4443Medicaid