Active NPI
Shannon Elyse Stewart, PA-C
- Physician Assistant
- Saint Louis, MO
National Provider Identifier
1104430776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2020028541
- Practice address
- 9556 Manchester Rd
Saint Louis, MO 63119-1313 - Phone
- (314) 961-2255
- NPI assigned
- Sep 1, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 2020028541 | MO | Primary |
Addresses
Primary practice location
9556 Manchester Rd
Saint Louis, MO 63119-1313
Mailing address
38 Snowmass CT
O Fallon, MO 63368-6677
Phone (636) 293-2634
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020028541 | MO | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598918400000",
"number": "1104430776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 SNOWMASS CT",
"city": "O FALLON",
"state": "MO",
"postal_code": "633686677",
"telephone_number": "636-293-2634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9556 MANCHESTER RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631191313",
"telephone_number": "314-961-2255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEWART",
"first_name": "SHANNON",
"middle_name": "ELYSE",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-01",
"last_updated": "2020-09-01",
"certification_date": "2020-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MO",
"license": "2020028541",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.