| Provider / Organization | NPI | Date Certified |
|---|---|---|
| SHANNON STARUK | 1295324838 | 2021-01-17 |
Shannon Staruk is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1295324838. Registration indicates Shannon Staruk is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers) (Student, Health Care, Student in an Organized Health Care Education/Training Program) (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)
| Entity Type | Individual |
| Provider Name | Shannon Staruk |
| Practice Office Address | 5 NEPONSET ST WORCESTER, MA US |
| Practice Office Telephone | 5083687800 |
| Mailing Address | 5 NEPONSET ST WORCESTER, MA 016062714 US |
| Address | City / State | Phone / Fax |
|---|---|---|
| 77 E Merrimack St Ste 22 | Lowell, MA 018521900 | 8335104357 |
| Code | Practice | License No State |
|---|---|---|
| 363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | PA8729
MA |
| 390200000X | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care |