Provider Demographics
NPI:1841957867
Name:SMITH, SHANNON LEIGH (CRNP)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 OGLETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-2153
Mailing Address - Country:US
Mailing Address - Phone:724-504-5548
Mailing Address - Fax:
Practice Address - Street 1:4075 MONROEVILLE BLVD STE 125
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2526
Practice Address - Country:US
Practice Address - Phone:412-373-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024281363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics