Provider Demographics
NPI:1861191173
Name:GUGLIOTTA, SHANNON M (CRNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:GUGLIOTTA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 PLEASANTON RD APT 31
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-9454
Mailing Address - Country:US
Mailing Address - Phone:443-821-4874
Mailing Address - Fax:
Practice Address - Street 1:2089 BROWN RD
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-1505
Practice Address - Country:US
Practice Address - Phone:410-375-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR239933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily