Provider Demographics
NPI:1922558360
Name:QUINN, SHANNON T (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:T
Last Name:QUINN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 FLOWER HILL RD
Mailing Address - Street 2:
Mailing Address - City:HALESITE
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2312
Mailing Address - Country:US
Mailing Address - Phone:516-445-7929
Mailing Address - Fax:
Practice Address - Street 1:222 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4842
Practice Address - Country:US
Practice Address - Phone:212-532-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY661491-1163W00000X
NY661491163WX0003X
NYF340372363LF0000X
NYF340372-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient