Individual
SHANNON MARIE REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4 W 58TH ST, NEW YORK, NY 10019-2515
(845) 826-4073
Mailing address
88 LEONARD ST APT 409, NEW YORK, NY 10013-3494
(845) 826-4073
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
F311012-01
NY
Other
Enumeration date
03/24/2023
Last updated
03/24/2023
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