SHANNON M. GODDARD PA NPI 1780961417

NPI Information

NPI: 1780961417
Provider Name: SHANNON M. GODDARD, PA
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: CIRCLE THE CITY

PECOS Registration: Yes

Address:
7592 BROADWAY
LEMON GROVE, CA
ZIP 91945
Phone: (619) 515-2300
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Shannon M. Goddard, PA is a medical physician assistant in Lemon Grove, CA with 13 years of experience. Shannon M. Goddard, PA NPI is 1780961417. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

7592 BROADWAY
LEMON GROVE, CA
ZIP 91945-604
Phone: (619) 515-2300

The NPI 1780961417 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/9/2011 and was last updated on 3/25/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363A00000X	Physician Assistant		3347	COLORADO	No
2	363AM0700X	Physician Assistant	Medical	56072	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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