Provider Demographics
NPI:1841785318
Name:STANTON, SHANNON MAUREEN
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MAUREEN
Last Name:STANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:EARLTON
Mailing Address - State:NY
Mailing Address - Zip Code:12058-0153
Mailing Address - Country:US
Mailing Address - Phone:518-810-5004
Mailing Address - Fax:
Practice Address - Street 1:803 GRANT ANE
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449
Practice Address - Country:US
Practice Address - Phone:845-331-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567729-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse