Individual
SHANNON ASHLEY MACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
1508066705
NY
208600000X
Surgery Physician
Primary
029209
NY
Other
Enumeration date
09/20/2022
Last updated
05/24/2023
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