# SHANNEN MOORE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1083092977
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WP0200X | Pediatric Registered Nurse | 701502 | NY | — |
| 363LP0200X | Pediatric Nurse Practitioner | 383018 | NY | Yes |
| 367500000X | Certified Registered Nurse Anesthetist | 701502 | NY | — |

## Other

- **Enumeration date:** 05/11/2015
- **Last updated:** 01/27/2026