Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shannon Dorothea Vassallo, PA

Individual provider Physician Assistant · NPI 1114357274

Shannon Dorothea Vassallo, PA is a Physician Assistant in Raleigh, North Carolina. Graduated from Mercy College in 2013, 13 years ago. Practices with North Carolina Mg LLC, a 712-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
13
Trained at
Mercy College
Licensed in
NC
In the registry since
2013
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

3801 Wake Forest Rd Ste 210
Raleigh, NC 27609-6864
Phone: (919) 787-7246
Fax: (919) 787-7247
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4207 Lake Boone Trl Ste 220, Raleigh, NC 27607-6685 — (919) 784-1410

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-04755 (NC)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1114357274
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedNovember 26, 2013
Last updated in NPPESDecember 11, 2020
Certification dateDecember 11, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolMERCY COLLEGE
Graduated 2013 (13 years in practice)
Group practice North Carolina Mg Llc — 712 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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