Provider Demographics
NPI:1154685808
Name:SHANNON, CINDY (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37215
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-7215
Mailing Address - Country:US
Mailing Address - Phone:202-302-8816
Mailing Address - Fax:
Practice Address - Street 1:7401 GREENBELT RD
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3402
Practice Address - Country:US
Practice Address - Phone:301-982-5428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1004656363LP0200X
MDR172234363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics