Provider Demographics
NPI:1669719332
Name:SUAREZ, SHANNYN TIERRA (RN)
Entity type:Individual
Prefix:MRS
First Name:SHANNYN
Middle Name:TIERRA
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:998 CROOKED HILL RD BLDG 82
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1019
Mailing Address - Country:US
Mailing Address - Phone:516-403-7673
Mailing Address - Fax:631-761-3769
Practice Address - Street 1:998 CROOKED HILL RD BLDG 82
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717
Practice Address - Country:US
Practice Address - Phone:516-403-7673
Practice Address - Fax:631-761-3769
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY661439-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse