Healthcare Provider Details

I. General information

NPI: 1467369652
Provider Name (Legal Business Name): SHANNON CARROLL NP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E 23RD ST STE 600
NEW YORK NY
10010-4580
US

IV. Provider business mailing address

125 E 23RD ST STE 500
NEW YORK NY
10010-4581
US

V. Phone/Fax

Practice location:
  • Phone: 347-525-8515
  • Fax: 520-441-3322
Mailing address:
  • Phone: 347-525-8515
  • Fax: 520-441-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANNON EUGENE CARROLL
Title or Position: FOUNDER
Credential: NP
Phone: 347-525-8515