Provider Demographics
NPI:1548234701
Name:HUDSON, SHANNON (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:90 MAIDEN LN
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4831
Mailing Address - Country:US
Mailing Address - Phone:646-290-9563
Mailing Address - Fax:212-532-4362
Practice Address - Street 1:90 MAIDEN LN
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4831
Practice Address - Country:US
Practice Address - Phone:646-290-9563
Practice Address - Fax:212-532-4362
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY211767207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
043748486OtherEMPIRE UNITED
113353533OtherMAGNACARE
9734198OtherGHI MEDICAID
NYP1943708OtherOXFORD
NY043748486OtherPHCS
211767OtherHIP
7163020OtherAETNA
043748486OtherMAGNACARE
2268814OtherUNITED HEALTH
NY6166533OtherCIGNA
NY043748486OtherHORIZON
043748486OtherBEECH ST
NYOMO764OtherHEALTHNET
NY043748486OtherGREAT WEST
NY043748486OtherMULTIPLAN
043748486OtherHUMANA INS
NY3170706OtherUSHC HMO
624D91OtherBCBS