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General NPI Number Information
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NPI Number | 1376067496
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Entity Type | Individual
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Provider Name | SHANNON SHAH NP
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Gender | Female
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Dates
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Enumeration Date | 07/31/2017
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 350 ENGLE ST
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1808
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Country | US
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Telephone | 201-894-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 155 CRYSTAL RUN RD
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City | MIDDLETOWN
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State | NY
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Zip | 10941-4028
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Country | US
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Telephone | 845-703-6999
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Fax | 845-703-6297
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F308256
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00913700
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License Number State | NJ
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