Active NPI
Sandra C. Shanahan, C.R.N.P.
- Pediatric Nurse Practitioner
- Hanover, MD
National Provider Identifier
1033101928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- R121329
- Practice address
- 7556 Teague Road
Suite 210
Hanover, MD 21076 - Phone
- (410) 551-0499
- Fax
- (410) 799-9070
- NPI assigned
- Aug 17, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | R121329 | MD | Primary |
Addresses
Primary practice location
7556 Teague Road
Suite 210
Hanover, MD 21076
Mailing address
1111 Benfield Blvd
Suite 200
Millersville, MD 21108-3002
Phone (410) 729-5100
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 641932-02 | Other | MD | CAREFIRST MD RENDERING OD |
| 405743100 | Medicaid | MD | |
| 7605-0067 | Other | MD | CAREFIRST BLUECHOICE |
| 107916 | Other | MD | JHHC PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R121329 | MD | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236816000000",
"number": "1033101928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 BENFIELD BLVD",
"address_2": "SUITE 200",
"city": "MILLERSVILLE",
"state": "MD",
"postal_code": "211083002",
"telephone_number": "410-729-5100",
"fax_number": "410-729-5156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7556 TEAGUE ROAD",
"address_2": "SUITE 210",
"city": "HANOVER",
"state": "MD",
"postal_code": "21076",
"telephone_number": "410-551-0499",
"fax_number": "410-799-9070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANAHAN",
"first_name": "SANDRA",
"middle_name": "C.",
"name_prefix": "Ms.",
"credential": "C.R.N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-17",
"last_updated": "2009-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MD",
"license": "R121329",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST MD RENDERING OD",
"identifier": "641932-02",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "405743100",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST BLUECHOICE",
"identifier": "7605-0067",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JHHC PROVIDER NUMBER",
"identifier": "107916",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hanover, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.