Provider Demographics
NPI:1598920530
Name:O'KEEFFE, SHANNON (NP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:O'KEEFFE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E 60TH ST
Mailing Address - Street 2:APT 27E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1514
Mailing Address - Country:US
Mailing Address - Phone:914-391-0358
Mailing Address - Fax:
Practice Address - Street 1:303 E 60TH ST
Practice Address - Street 2:APT 27E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1514
Practice Address - Country:US
Practice Address - Phone:914-391-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430402-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care