Individual
MS. SHANNON DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
31 ARNOT RD, SUITE A, HORSEHEADS, NY 14845-8533
(607) 739-3874
(607) 739-3632
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F320015-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02388796
—
NY
01
—
CC8362
RR MEDICARE GROUP
NY
01
—
P00098788
RR MEDICARE PIN
NY
Enumeration date
03/16/2006
Last updated
06/22/2011
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