Provider Demographics
NPI:1912650953
Name:COHOLAN, SHANNON M (RN, BSN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:COHOLAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 COVE RD
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2489
Mailing Address - Country:US
Mailing Address - Phone:315-715-2650
Mailing Address - Fax:
Practice Address - Street 1:56 COVE RD
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2489
Practice Address - Country:US
Practice Address - Phone:315-715-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY824271-01163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool