Provider Demographics
NPI:1952160459
Name:CONWAY, SHANNON (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SAW MILL LN
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-2308
Mailing Address - Country:US
Mailing Address - Phone:401-354-9472
Mailing Address - Fax:
Practice Address - Street 1:19 SAW MILL LN
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-2308
Practice Address - Country:US
Practice Address - Phone:401-354-9472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-642543163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant