Individual
LISA KATHERINE THEOBALD SHANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
530 1ST AVE STE 10Q, NEW YORK, NY 10016-6402
(631) 376-4060
Mailing address
530 1ST AVE STE 10Q, NEW YORK, NY 10016-6402
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
303994-01
NY
Other
Enumeration date
06/20/2016
Last updated
03/31/2021
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