Basic Information
| Provider Information | |||||||||
| NPI: | 1760521538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCLOUGHLIN DALEY | ||||||||
| FirstName: | SHANNON | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 654 E JERSEY ST | ||||||||
| Address2: | |||||||||
| City: | ELIZABETH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 072061261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089947290 | ||||||||
| FaxNumber: | 9089947054 | ||||||||
| Practice Location | |||||||||
| Address1: | 654 E JERSEY ST | ||||||||
| Address2: | |||||||||
| City: | ELIZABETH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 072061261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089947290 | ||||||||
| FaxNumber: | 9089947054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 03/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | 26NCO4273800 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
No ID Information.