MEDICARE: SHANNON CONWAY RN, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	22-642543	NY

General Provider Information

NPI Number	:	1952160459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON CONWAY RN, IBCLC

Provider Business Mailing Address
First Line	:	19 SAW MILL LN
Second Line	:
City	:	COLD SPRING HARBOR
State	:	NY
Zip	:	11724-2308
Country	:	US
Telephone Number	:	401-354-9472
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 SAW MILL LN
Second Line	:
City	:	COLD SPRING HARBOR
State	:	NY
Zip	:	11724-2308
Country	:	US
Telephone Number	:	401-354-9472
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	03/18/2024

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