Provider Demographics
NPI:1053097998
Name:SHONNARD, DANIEL (PA-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SHONNARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:906-370-8663
Mailing Address - Fax:
Practice Address - Street 1:TH MICHIGAN HEART
Practice Address - Street 2:5325 ELLIOT DRIVE 2ND FLOOR
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-8000
Practice Address - Fax:734-712-8010
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MI390200000X
MI5601011969363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program