Provider Demographics
NPI:1548843444
Name:DONNELL, SHANNON SMITH (RN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:SMITH
Last Name:DONNELL
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 1:330 GEORGE SICKLE RD
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-3211
Mailing Address - Country:US
Mailing Address - Phone:518-364-9822
Mailing Address - Fax:
Practice Address - Street 1:330 GEORGE SICKLE RD
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-3211
Practice Address - Country:US
Practice Address - Phone:518-364-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY551713-1163WC1500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY551713-1OtherREGISTERED PROFESSIONAL NURSE LICENSE