Individual
SHANNON GRACE TISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2222 N NEVADA AVE STE 4007, COLORADO SPRINGS, CO 80907
(719) 776-8500
Mailing address
300 COMMUNITY DR, MANHASSET, NY 11030-3876
(516) 562-4100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3496
TN
363A00000X
Physician Assistant
Primary
5770
CO
363AM0700X
Medical Physician Assistant
23019471
NY
Other
Enumeration date
02/05/2016
Last updated
12/17/2023
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