Provider Demographics
NPI:1578729448
Name:ZINN, SHANNON L (FNP)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:L
Last Name:ZINN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-771-2220
Mailing Address - Fax:607-771-2225
Practice Address - Street 1:510 S 4TH ST STE 140
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2952
Practice Address - Country:US
Practice Address - Phone:315-349-5873
Practice Address - Fax:315-349-5921
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03035114Medicaid
NYJ400058815Medicare PIN