Individual
MR. GRANT SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
206 CORNELIA ST, SUITE 105, PLATTSBURGH, NY 12901-2878
(518) 561-5516
Mailing address
206 CORNELIA ST, SUITE 105, PLATTSBURGH, NY 12901-2878
(518) 561-5516
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F308051-1
NY
Other
Enumeration date
12/29/2016
Last updated
05/11/2017
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