Provider Demographics
NPI:1033101928
Name:SHANAHAN, SANDRA C (CRNP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:C
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:7556 TEAGUE ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076
Practice Address - Country:US
Practice Address - Phone:410-551-0499
Practice Address - Fax:410-799-9070
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2009-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR121329363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD641932-02OtherCAREFIRST MD RENDERING OD
MD405743100Medicaid
MD7605-0067OtherCAREFIRST BLUECHOICE
MD107916OtherJHHC PROVIDER NUMBER
MD7605-0067OtherCAREFIRST BLUECHOICE
MD641932-02OtherCAREFIRST MD RENDERING OD