Provider Demographics
NPI:1295092070
Name:DEVORE, SHANNON MICHELE (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MICHELE
Last Name:DEVORE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:700 HICKSVILLE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3472
Mailing Address - Country:US
Mailing Address - Phone:267-339-7843
Mailing Address - Fax:
Practice Address - Street 1:159 E 53RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4602
Practice Address - Country:US
Practice Address - Phone:212-263-7981
Practice Address - Fax:212-263-8827
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY279060207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty