Provider Demographics
NPI:1215957253
Name:SHANAHAN, JAMES A (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:SHANAHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CRYSTAL FARM RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2864
Mailing Address - Country:US
Mailing Address - Phone:845-986-1679
Mailing Address - Fax:
Practice Address - Street 1:37 CRYSTAL FARM RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-2864
Practice Address - Country:US
Practice Address - Phone:845-986-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173678207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
821622OtherUNITED HEALTHCARE
62721OtherAETNA
1883OtherGHI/HMO
167018OtherMVP
YP054OtherOXFORD
NY01198127Medicaid
72017OtherGHI
3C0826OtherHEALTHNET
6231379004OtherCIGNA
3C0826OtherHEALTHNET
NY01198127Medicaid