Active NPI
Shannon Pavlak
- Physician Assistant
- East Lansing, MI
National Provider Identifier
1063393718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 909 Wilson Rd
East Lansing, MI 48824-6410 - Phone
- (517) 353-2460
- NPI assigned
- Sep 9, 2025
- Last updated
- Apr 22, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | NU | Primary |
Addresses
Primary practice location
909 Wilson Rd
East Lansing, MI 48824-6410
Mailing address
909 Wilson Rd
East Lansing, MI 48824-6410
Phone (517) 353-2460
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1757376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776816000000",
"number": "1063393718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "909 WILSON RD",
"city": "EAST LANSING",
"state": "MI",
"postal_code": "488246410",
"telephone_number": "517-353-2460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "909 WILSON RD",
"city": "EAST LANSING",
"state": "MI",
"postal_code": "488246410",
"telephone_number": "517-353-2460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAVLAK",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-09",
"last_updated": "2026-04-22",
"certification_date": "2026-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Lansing, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.