Individual
SHANNON LAW-CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 SEYMOUR ST, MONTCLAIR, NJ 07042-3771
(973) 302-6025
(862) 357-8424
Mailing address
54A HERCULES RD, KENVIL, NJ 07847-2674
(973) 699-7861
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
25MP00788200
NJ
363AS0400X
Surgical Physician Assistant
Primary
25MP00788200
NJ
Other
Enumeration date
06/21/2023
Last updated
09/13/2023
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