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General NPI Number Information
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NPI Number | 1285301499
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Entity Type | Individual
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Provider Name | SHANNON THERESA BAILEY NP
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Gender | Female
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 562 NJ - 23
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City | POMPTON PLAINS
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State | NJ
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Zip | 07444
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Country | US
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Telephone | 973-616-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 1092 MACOPIN RD
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City | WEST MILFORD
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State | NJ
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Zip | 07480-1509
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Country | US
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Telephone | 707-479-2963
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024182216
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ14891300
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License Number State | NJ
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