Healthcare Provider Details

I. General information

NPI: 1871816801
Provider Name (Legal Business Name): ALLISON SHANNADEAN GORDON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON SHANNADEAN GORDON RN

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 NY-17K STE 202
NEWBURGH NY
12550
US

IV. Provider business mailing address

254 NY-17K STE 202
NEWBURGH NY
12550
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-1359
  • Fax:
Mailing address:
  • Phone: 845-471-1359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2953861
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number748965
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: