Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Shannon Jeanne Radkovich, PA-C

Individual provider Physician Assistant · NPI 1215292099

Shannon Jeanne Radkovich, PA-C is a Physician Assistant in Randolph, New Jersey. Qualified in 2012, 14 years ago. Practices with Practice Associates Medical Group, a 1,403-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in New Jersey.

Years since qualifying
14
Licensed in
NJ
In the registry since
2012
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

714 Route 10 W
Randolph, NJ 07869-2058
Phone: (973) 891-1213
Fax: (973) 891-1216
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1 Diamond Hill Rd, Berkeley Heights, NJ 07922-2104 — (908) 273-4300

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 25MP00285900 (NJ)

Record details

NPI number1215292099
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJuly 9, 2012
Last updated in NPPESMay 10, 2023
Certification dateMay 10, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Practice Associates Medical Group — 1403 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Randolph