Individual
PATRICK KEENAN SHANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1219 GUSDORF RD STE A, TAOS, NM 87571-6499
(505) 758-0009
(505) 758-8736
Mailing address
1397 WEIMER RD, TAOS, NM 87571-6253
(505) 758-0009
(505) 758-8736
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA2008-0045
NM
Other
Enumeration date
05/14/2008
Last updated
06/17/2016
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