Provider Demographics
NPI:1255046546
Name:GEORGOV, SHANNAN (NP)
Entity type:Individual
Prefix:MRS
First Name:SHANNAN
Middle Name:
Last Name:GEORGOV
Suffix:
Gender:
Credentials:NP
Other - Prefix:MS
Other - First Name:SHANNAN
Other - Middle Name:
Other - Last Name:HARKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:100 DISCOVERY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-1325
Mailing Address - Country:US
Mailing Address - Phone:302-866-9704
Mailing Address - Fax:
Practice Address - Street 1:100 DISCOVERY BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-1325
Practice Address - Country:US
Practice Address - Phone:302-866-9704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026462363LG0600X, 363LP2300X, 363L00000X
DELP-0010674363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care