Provider Demographics
NPI:1508329095
Name:ELSIS, SHANNON (LPN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:ELSIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:BARRESI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:84 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-1102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:84 OLD POST RD
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-1102
Practice Address - Country:US
Practice Address - Phone:631-828-3879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304457164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse