# SHANNON MARIE MASTERSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1326516766
- **Gender:** F
- **Credential:** MPAS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | MA060355 | PA | — |
| 363AS0400X | Surgical Physician Assistant | MA060355 | PA | Yes |

## Other

- **Enumeration date:** 11/04/2018
- **Last updated:** 10/07/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 103608062 | — | PA |
| 01 | — | 14382009 | CAQH | — |