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General NPI Number Information
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NPI Number | 1467112813
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Entity Type | Individual
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Provider Name | CHANG SHANNON LEE NP
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Gender | Female
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 01/01/2022
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Provider Practice Location Address
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Address Line | 110 IRVING ST NW
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City | WASHINGTON
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State | DC
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Zip | 20010-3017
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Country | US
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Telephone | 202-877-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 106 W 96TH ST APT 3D
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City | NEW YORK
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State | NY
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Zip | 10025-6410
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Country | US
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Telephone | 201-543-7749
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 432225
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License Number State | NY
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