Healthcare Provider Details

I. General information

NPI: 1285972067
Provider Name (Legal Business Name): SHANNON LEE RADACI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON LEE MOLYNEAUX

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 SAMANTHA WAY
NORTH HUNTINGDON PA
15642-5800
US

IV. Provider business mailing address

1389 SAMANTHA WAY
NORTH HUNTINGDON PA
15642-5800
US

V. Phone/Fax

Practice location:
  • Phone: 724-309-2538
  • Fax: 724-835-7231
Mailing address:
  • Phone: 724-309-2538
  • Fax: 724-835-7231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP012506
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: