Individual
SHANNON R DINGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
4867 BROADWAY, #839, NEW YORK, NY 10034
(646) 830-4735
Mailing address
4867 BROADWAY, #839, NEW YORK, NY 10034
(646) 830-4735
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F402317
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
402317
NURSE PRACTITIONER LICENSE
NY
Enumeration date
07/24/2016
Last updated
09/25/2024
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