Basic Information
| Provider Information | |||||||||
| NPI: | 1013583491 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHANNON | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | TERESA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 MAJOR APPLEBY RD | ||||||||
| Address2: | |||||||||
| City: | ARDSLEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105021615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146488072 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 PONDFIELD RD | ||||||||
| Address2: | |||||||||
| City: | BRONXVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107083706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147871000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2021 | ||||||||
| LastUpdateDate: | 09/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 347072 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.