Provider Demographics
NPI:1962247221
Name:SHANNON, QUANISHA J (RN)
Entity type:Individual
Prefix:
First Name:QUANISHA
Middle Name:J
Last Name:SHANNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3813
Mailing Address - Country:US
Mailing Address - Phone:631-696-9669
Mailing Address - Fax:
Practice Address - Street 1:42 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3813
Practice Address - Country:US
Practice Address - Phone:631-696-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY672749163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health