Individual
SHANNON HAYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3535 SOUTHERN BLVD, DAYTON, OH 45429-1221
(937) 298-4331
Mailing address
8705 CREEKSCAPE LN APT 824, CINCINNATI, OH 45249-2063
(440) 251-4816
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.006576RX
OH
363AM0700X
Medical Physician Assistant
50.006576RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1160649
NCCPA
—
Enumeration date
08/18/2020
Last updated
11/12/2024
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