| Doctor Name: | MR. SHANNON LESLIE HERSHBERGER |
| NPI Number: | 1215173059 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 0010-01640 |
| Business Practice Address: | 812 Candy Park Rd Pembroke, NC - 283729129 |
| Business Phone Number: | 9105210564 |
| Business Fax Number: | 9105218091 |
| Mailing Address: | 2600 N Elm St, LUMBERTON |
| State: | NC |
| Postal Code: | 283583011 |
| Phone Number: | 9102723051 |
| Fax Number: | 9107383764 |
| NPI Enumeration Date: | 12/29/2008 |
| NPI Last Update Date: | 05/31/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 0010-01640 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |