Shannon J Radkovich, PA-C
Physician Assistant in Randolph, New Jersey
1215292099- Practice location
- 714 Route 10 W, Randolph, NJ 07869-2058
- Phone
- 973-891-1213
- Fax
- 973-891-1216
- Last updated
- May 10, 2023
Shannon Jeanne Radkovich is a Physician Assistant based in Randolph, NJ. Shannon Jeanne Radkovich practices in Randolph, NJ and has the professional credentials of PA-C. The NPI Number for Shannon Jeanne Radkovich is 1215292099 and holds a License No. 25MP00285900 (NJ). The current practice location address for Shannon Jeanne Radkovich is 714 Route 10 W, Randolph, NJ 07869-2058 and can be reached out via phone at 973-891-1213 and via fax at 973-891-1216.
Provider Profile Details
- NPI Number
- 1215292099
- Provider Name
- Shannon Jeanne Radkovich
- Credential
- PA-C
- Provider Entity Type
- Individual
- Gender
- Female
- Address
- 714 Route 10 W, Randolph, NJ 07869-2058
- Phone Number
- 973-891-1213
- Fax Number
- 973-891-1216
- Primary Taxonomy
- Physician Assistant · 363A00000X
- Sole Proprietor
- No
- Provider Enumeration Date
- July 9, 2012
- Last Update Date
- May 10, 2023
- Certification Date
- May 10, 2023
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 714 Route 10 W
Randolph, NJ 07869-2058 - City
- Randolph
- State
- New Jersey
- Zip
- 07869-2058
- Phone Number
- 973-891-1213
- Fax Number
- 973-891-1216
Provider Business Mailing Address Details
- Address
- Po Box 416457
Boston, MA 02241-6457 - City
- Boston
- State
- MA
- Zip
- 02241-6457
- Phone Number
- 844-362-1735
- Fax Number
- 973-290-7495
License Information
- License Number
- 25MP00285900
- License State
- NJ
- Taxonomy
- Physician Assistant · 363A00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Physician Assistants near Randolph, NJ
View all Physician Assistants in Randolph →Frequently Asked Questions
What is the NPI number of Shannon J Radkovich, PA-C?
The NPI number of Shannon J Radkovich, PA-C is 1215292099. It was assigned on July 9, 2012 and is currently active in the NPPES registry.
What is the specialty of Shannon J Radkovich, PA-C?
Shannon J Radkovich, PA-C is registered under the primary taxonomy Physician Assistant (code 363A00000X), licensed in NJ under license number 25MP00285900.
Where does Shannon J Radkovich, PA-C practice?
The practice location is 714 Route 10 W, Randolph, NJ 07869-2058. The office can be reached at 973-891-1213 (phone) or 973-891-1216 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1215292099 directly on the NPPES registry website.