Provider Demographics
NPI:1285972067
Name:RADACI, SHANNON LEE (CRNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:RADACI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEE
Other - Last Name:MOLYNEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1389 SAMANTHA WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-5800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5609 5TH AVE
Practice Address - Street 2:HEARTLAND CARE PARTNERS
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-2601
Practice Address - Country:US
Practice Address - Phone:800-375-5495
Practice Address - Fax:800-564-5952
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012506363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner