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General NPI Number Information
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NPI Number | 1720449747
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Entity Type | Individual
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Provider Name | SHANNON REYNOLDS CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 120 VALLEY GREEN LN STE 510
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2080
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Country | US
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Telephone | 484-324-7171
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Fax |
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Provider Business Mailing Address
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Address Line | 3803 W CHESTER PIKE STE 160
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-2336
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Country | US
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Telephone | 484-337-1632
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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 | SP015801
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License Number State | PA
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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 | SP015801
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License Number State | PA
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