Provider Demographics
NPI:1790576676
Name:BANDY, SHANNON RENEE (RN)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:RENEE
Last Name:BANDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170-1265
Mailing Address - Country:US
Mailing Address - Phone:304-684-2215
Mailing Address - Fax:304-684-3569
Practice Address - Street 1:202 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-1265
Practice Address - Country:US
Practice Address - Phone:304-684-2215
Practice Address - Fax:304-684-3569
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH383340163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool