Individual
HEATHER M SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
522 S 4TH ST STE 500, FULTON, NY 13069
(315) 598-4740
(315) 598-4728
Mailing address
239 ONEIDA ST, FULTON, NY 13069-1228
(315) 598-4715
(315) 598-4751
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
00420826
NY
367A00000X
Advanced Practice Midwife
F000678-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02381762
—
NY
Enumeration date
10/27/2005
Last updated
09/10/2025
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