Provider Demographics
NPI:1831424746
Name:ENDERS, SHANNON MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:ENDERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:HOURIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 PRESIDENTIAL PLZ STE 214
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2292
Mailing Address - Country:US
Mailing Address - Phone:315-299-5451
Mailing Address - Fax:315-299-4710
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:ANESTHESIA GROUP OF ONONDAGA, PC
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5440
Practice Address - Fax:315-472-5010
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500174-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered