=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922558360
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON T QUINN FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2016
-----------------------------------------------------
Last Update Date | 01/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 E 34TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-4842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-532-2354
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 187 FLOWER HILL RD
-----------------------------------------------------
City | HALESITE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11743-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-445-7929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 661491-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WX0003X
-----------------------------------------------------
Taxonomy Name | Inpatient Obstetric Registered Nurse
-----------------------------------------------------
License Number | 661491
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F340372
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F340372-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------