Healthcare Provider Details

I. General information

NPI: 1255046546
Provider Name (Legal Business Name): SHANNAN GEORGOV NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNAN HARKINS NP

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DISCOVERY BLVD
NEWARK DE
19713-1325
US

IV. Provider business mailing address

100 DISCOVERY BLVD STE 101
NEWARK DE
19713-1325
US

V. Phone/Fax

Practice location:
  • Phone: 302-866-9704
  • Fax:
Mailing address:
  • Phone: 302-866-9704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP026462
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP026462
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0010674
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP026462
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: