Individual
SHANNON JEANNE RADKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
714 ROUTE 10 W, RANDOLPH, NJ 07869-2058
(973) 891-1213
(973) 891-1216
Mailing address
PO BOX 416457, BOSTON, MA 02241-6457
(844) 362-1735
(973) 290-7495
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00285900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215292099
NPI
—
Enumeration date
07/09/2012
Last updated
05/10/2023
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