Provider Demographics
NPI:1518383223
Name:SHANNON, ROBIN SUE (PMHNP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:SUE
Last Name:SHANNON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MAIN ST STE 15
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-3753
Mailing Address - Country:US
Mailing Address - Phone:508-660-1666
Mailing Address - Fax:508-660-1667
Practice Address - Street 1:420 MAIN ST STE 15
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-3753
Practice Address - Country:US
Practice Address - Phone:508-660-1666
Practice Address - Fax:508-660-1667
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006766363L00000X, 363LF0000X
MARN2326129363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1518383223Medicaid
SCNP4339Medicaid
NCNCH846DMedicare PIN
NCNCH846BMedicare PIN
NCNCH846CMedicare PIN
NC1518383223Medicaid
NCNCH846AMedicare PIN