Provider Demographics
NPI:1437243417
Name:SMITH, SHANNON MARIE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2463 WALTERS CT
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4822
Mailing Address - Country:US
Mailing Address - Phone:585-748-9678
Mailing Address - Fax:
Practice Address - Street 1:2463 WALTERS CT
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-4822
Practice Address - Country:US
Practice Address - Phone:585-748-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284966164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse