Provider Demographics
NPI:1366862294
Name:SHANNON, CHENISA
Entity type:Individual
Prefix:MS
First Name:CHENISA
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 JFK PKWY
Mailing Address - Street 2:FL 1
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2713
Mailing Address - Country:US
Mailing Address - Phone:800-960-0737
Mailing Address - Fax:973-621-6002
Practice Address - Street 1:196 RENNER AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2110
Practice Address - Country:US
Practice Address - Phone:973-417-8742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health