Healthcare Provider Details

I. General information

NPI: 1831424746
Provider Name (Legal Business Name): SHANNON MARIE ENDERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON MARIE HOURIGAN

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE ANESTHESIA GROUP OF ONONDAGA, PC
SYRACUSE NY
13203-1807
US

IV. Provider business mailing address

60 PRESIDENTIAL PLZ STE 214
SYRACUSE NY
13202-2292
US

V. Phone/Fax

Practice location:
  • Phone: 315-448-5440
  • Fax: 315-472-5010
Mailing address:
  • Phone: 315-299-5451
  • Fax: 315-299-4710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number500174-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: