Shannon Dorothea Vassallo, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-04755 Issued in NC

Practice address

3801 Wake Forest Rd Ste 210
Raleigh, NC 27609-6864

Phone

(919) 787-7246

Fax

(919) 787-7247

NPI assigned

Nov 26, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Shannon Nardozzi Former name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Mercy College, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Carolina MG LLCGroup PAC ID 1951828847, 723 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rex Hospital Hospital, Raleigh, NC, CCN 340114

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Carolina MG, LLC

  • Hospitalist Physician
  • Raleigh, NC
  • NPI 1215741640
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Rex Hospital Inc.

  • General Acute Care Hospital
  • Raleigh, NC
  • NPI 1497797088
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1114357274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 WAKE FOREST RD STE 210",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096864",
            "telephone_number": "919-787-7246",
            "fax_number": "919-787-7247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 WAKE FOREST RD STE 210",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096864",
            "telephone_number": "919-787-7246",
            "fax_number": "919-787-7247"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4207 Lake Boone Trl Ste 220",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276076685",
            "country_code": "US",
            "telephone_number": "919-784-1410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VASSALLO",
        "first_name": "SHANNON",
        "middle_name": "DOROTHEA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-26",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-04755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "NARDOZZI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sophia Vasely
• Sarit Vaserman, FNP
• Maria Dessiret Vasquez Acosta
• Angele Vasquez
• Karen M Vasquez, LCSW
• Marni Vasseur
• Barbara Carol Vatz, PH.D.
• Elizabeth Schuyler Vaughan Coonse, LCSW-A
• Alexis Vaughan
• Anne Vaughan, LPT

• Physician Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.