Provider Demographics
NPI:1912293820
Name:AUSTIN, SHANNON RAECHEL (RN)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:RAECHEL
Last Name:AUSTIN
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 1:5 BARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-1410
Mailing Address - Country:US
Mailing Address - Phone:631-909-8301
Mailing Address - Fax:
Practice Address - Street 1:5 BARBERRY LN
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-1410
Practice Address - Country:US
Practice Address - Phone:631-909-8301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY516598-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse