Provider Demographics
NPI:1023246899
Name:NEUROHR, SHANNON E (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:E
Last Name:NEUROHR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:E
Other - Last Name:BONANNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:647 N BROAD STREET EXT
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-4604
Mailing Address - Country:US
Mailing Address - Phone:724-458-8460
Mailing Address - Fax:724-458-0137
Practice Address - Street 1:647 N BROAD STREET EXT
Practice Address - Street 2:SUITE 107
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-4604
Practice Address - Country:US
Practice Address - Phone:724-458-8460
Practice Address - Fax:724-458-0137
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053880363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA424060NJKMedicare PIN