Individual
MRS. SHANNON ELIZABETH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
83 LEWIS ST, DRYDEN, NY 13053
(607) 844-8201
(607) 844-4922
Mailing address
4 FERNDALE LN, HOMER, NY 13077-9418
(607) 749-6511
(607) 844-4922
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
007939-1
NY
Other
Enumeration date
11/08/2006
Last updated
07/08/2007
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