Healthcare Provider Details

I. General information

NPI: 1730430786
Provider Name (Legal Business Name): SHANNON PATRICIA MORE JARZYNKA DNP, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2012
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

202 W 78TH ST APT 1E
NEW YORK NY
10024-6665
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5875
  • Fax:
Mailing address:
  • Phone: 908-399-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382361
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number644299
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: