Healthcare Provider Details

I. General information

NPI: 1548196058
Provider Name (Legal Business Name): SHANNON BRIENZA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

14 ADMIRAL RD
MASSAPEQUA NY
11758-7814
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7000
  • Fax:
Mailing address:
  • Phone: 516-457-7173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number772026
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number772026
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: