Provider Demographics
NPI:1366492860
Name:RAY, SHANNON (PA-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:64-1032 MAMALAHOA HWY
Mailing Address - Street 2:STE 306
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8441
Mailing Address - Country:US
Mailing Address - Phone:808-969-1427
Mailing Address - Fax:808-961-4795
Practice Address - Street 1:1120A MAKAWAO AVE
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9448
Practice Address - Country:US
Practice Address - Phone:808-573-2222
Practice Address - Fax:808-829-3673
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIAMD221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant