Healthcare Provider Details

I. General information

NPI: 1720717333
Provider Name (Legal Business Name): SHANNON SCHNEPF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N WASHINGTON AVE
GREEN BROOK NJ
08812-2698
US

IV. Provider business mailing address

26 NAGLE DR
SOMERVILLE NJ
08876-1722
US

V. Phone/Fax

Practice location:
  • Phone: 732-968-8900
  • Fax:
Mailing address:
  • Phone: 908-627-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: