Provider Demographics
NPI:1295612398
Name:KEHOE, SHANNON MARY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARY
Last Name:KEHOE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SUMMERRULES RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1095
Mailing Address - Country:US
Mailing Address - Phone:858-880-5976
Mailing Address - Fax:
Practice Address - Street 1:107 SUMMERRULES RD
Practice Address - Street 2:
Practice Address - City:WAVERLY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-1095
Practice Address - Country:US
Practice Address - Phone:858-880-5976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP033640363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health