Provider Demographics
NPI:1114523982
Name:SHANNON, ILONE COSETTA
Entity Type:Individual
Prefix:
First Name:ILONE
Middle Name:COSETTA
Last Name:SHANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ROSEHILL PL
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3050
Mailing Address - Country:US
Mailing Address - Phone:973-845-8222
Mailing Address - Fax:
Practice Address - Street 1:110 ROSEHILL PL
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3050
Practice Address - Country:US
Practice Address - Phone:973-845-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty