Provider Demographics
NPI:1336505692
Name:ANDREWS, SHANNON JOETTE (MSED)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:JOETTE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CLOVERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-9742
Mailing Address - Country:US
Mailing Address - Phone:914-213-3207
Mailing Address - Fax:
Practice Address - Street 1:16 CLOVERLEAF DR
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-9742
Practice Address - Country:US
Practice Address - Phone:914-213-3207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-02
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1154053171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator