Individual
SHANNON KATHLEEN CORCORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
955 EASTWIND DR, WESTERVILLE, OH 43081-3376
(888) 444-1203
(614) 268-7849
Mailing address
955 EASTWIND DR, WESTERVILLE, OH 43081-3376
(614) 268-9561
(614) 268-7849
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
50.003075
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00900285
RR MEDICARE
—
Enumeration date
06/29/2009
Last updated
06/19/2013
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