Healthcare Provider Details

I. General information

NPI: 1043129679
Provider Name (Legal Business Name): MS. SHANNON PATRICIA DELANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 SARANAC AVE
LAKE PLACID NY
12946-1152
US

IV. Provider business mailing address

2215 SARANAC AVE
LAKE PLACID NY
12946-1152
US

V. Phone/Fax

Practice location:
  • Phone: 802-598-3131
  • Fax:
Mailing address:
  • Phone: 802-598-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number731820-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: