Individual
MS. SHANNON LYNN WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
(410) 521-2200
Mailing address
1464 ROCKRIDGE RD, JARRETTSVILLE, MD 21084-1302
(443) 981-9539
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0007101
MD
363AM0700X
Medical Physician Assistant
C0007101
MD
363AS0400X
Surgical Physician Assistant
C0007101
MD
Other
Enumeration date
06/17/2019
Last updated
06/17/2019
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