Widderick, Shannon M.

Widderick, Shannon M. is an individual health care provider with primary practice located at 395 Pleasant St , Northampton MA 01060-3914. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Widderick, Shannon M. can be contacted via phone (413) 584-7787.

Contact Information

Primary practice address
395 Pleasant St Northampton MA 01060-3914
Phone: (413) 584-7787
Fax: (413) 584-7778
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 001992 Connecticut
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2360 Massachusetts
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA2360 Massachusetts

Profile Details

NPI number 1942482914
LBN Legal business name Widderick, Shannon M.
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 3rd, 2007
Last updated Jan 2nd, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942482914 NPPES
Connecticut MEDICAID 003019924

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