Individual
MS. SANDRA C. SHANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.P.
Contact information
Practice address
7556 TEAGUE ROAD, SUITE 210, HANOVER, MD 21076
(410) 551-0499
(410) 799-9070
Mailing address
1111 BENFIELD BLVD, SUITE 200, MILLERSVILLE, MD 21108-3002
(410) 729-5100
(410) 729-5156
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R121329
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107916
JHHC PROVIDER NUMBER
MD
05
—
405743100
—
MD
01
—
641932-02
CAREFIRST MD RENDERING OD
MD
01
—
7605-0067
CAREFIRST BLUECHOICE
MD
Enumeration date
08/17/2005
Last updated
03/12/2009
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