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General NPI Number Information
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NPI Number | 1932643947
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Entity Type | Individual
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Provider Name | SHANNON MALLOY-CRAIG
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Gender | Female
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Dates
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Enumeration Date | 12/09/2016
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 110 MARTER AVE STE 102
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3124
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Country | US
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Telephone | 856-235-6565
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Fax | 856-235-6566
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Provider Business Mailing Address
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Address Line | 1113 CEDAR AVE
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City | PITMAN
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State | NJ
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Zip | 08071-1917
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Country | US
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Telephone | 856-498-5433
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Fax | 856-582-4400
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NR14819100
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License Number State | NJ
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