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Individual

SHANNON MARIE CONVERY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
5172 LEAVITT RD, LORAIN, OH 44053-2384
(440) 282-3385
Mailing address
4211 WOOSTER RD, FAIRVIEW PARK, OH 44126-3417
(440) 289-7243

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1052607 NCCPA NUMBER
TX
363AM0700X
Medical Physician Assistant
Primary
50.002241
OH
363AM0700X
Medical Physician Assistant
PA03157
TX

Other

Enumeration date
10/14/2010
Last updated
11/18/2020
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