Individual
TRACY SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
75 MONTGOMERY ST FL 603, JERSEY CITY, NJ 07302-3726
(201) 433-1955
Mailing address
75 MONTGOMERY ST FL 603, JERSEY CITY, NJ 07302-3726
(201) 433-1955
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
345858
NY
Other
Enumeration date
12/20/2020
Last updated
07/02/2021
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