=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598907446
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON LYNNE DELANEY MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2009
-----------------------------------------------------
Last Update Date | 08/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800A 5TH AVE STE 203
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-7215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-856-9592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800A 5TH AVE STE 203
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-7215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-856-9592
-----------------------------------------------------
Fax | 415-376-4456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | 265620
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------