Provider Demographics
NPI:1235798521
Name:BELLITTIERI, SHANNON BREE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:BREE
Last Name:BELLITTIERI
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 1:48 VAN BOMEL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-2025
Mailing Address - Country:US
Mailing Address - Phone:631-560-6614
Mailing Address - Fax:
Practice Address - Street 1:26 COLONY DR
Practice Address - Street 2:
Practice Address - City:WEST SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11796-1611
Practice Address - Country:US
Practice Address - Phone:631-567-9652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7669821163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse