Provider Demographics
NPI:1134726722
Name:SNOOK, SHANNON MICHELLE (FNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELLE
Last Name:SNOOK
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 1:815 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2309
Mailing Address - Country:US
Mailing Address - Phone:908-245-3446
Mailing Address - Fax:
Practice Address - Street 1:815 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2309
Practice Address - Country:US
Practice Address - Phone:908-245-3446
Practice Address - Fax:908-245-9265
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346338363LF0000X
NJ26NJ01070600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily