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Individual
SHANE MICHAEL MORONG
Active
Individual
SHANE MICHAEL MORONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
57632
CA
363A00000X
Physician Assistant
PA1551
ME
363AS0400X
Surgical Physician Assistant
C0005588
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821492323
—
ME
Enumeration date
10/14/2014
Last updated
06/29/2023
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