Individual
SHANNYN WALDRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 FODEN RD, EAST, SUITE 100, SOUTH PORTLAND, ME 04106
(207) 523-3700
(207) 523-8590
Mailing address
100 GANNETT DR, SUITE C, SOUTH PORTLAND, ME 04106-5900
(207) 828-0361
(207) 874-1483
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1539
ME
363AM0700X
Medical Physician Assistant
PA2349
MA
Other
Enumeration date
09/06/2007
Last updated
09/08/2016
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