Provider Demographics
NPI:1386959716
Name:O'MEARA, SHANNON LAUREN (FNP)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LAUREN
Last Name:O'MEARA
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:250 DELAWARE AVE STE 100
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1402
Practice Address - Country:US
Practice Address - Phone:518-439-8077
Practice Address - Fax:518-439-8070
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY336401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1386959716Medicaid
NYJ400031434Medicare PIN