Provider Demographics
NPI:1669049599
Name:STRONG, SHANNON LEIGH (FNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:STRONG
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 1:8 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6506
Mailing Address - Country:US
Mailing Address - Phone:315-402-3681
Mailing Address - Fax:
Practice Address - Street 1:8 STANLEY AVE
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6506
Practice Address - Country:US
Practice Address - Phone:315-402-3681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY575704163W00000X
NY347997363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse