Shannon M Andersen, BSN, FNP-BC, AOCNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

335789 Issued in NY

Practice address

1275 York Ave
Floor 4, Suite 4
New York, NY 10065-6007

Phone

(212) 639-2110

NPI assigned

Aug 27, 2009

Last updated

Oct 24, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Shannon M Kortekaas Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor on Science - Nursing, Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382572800000",
    "number": "1871726612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "296 DEKALB AVE",
            "address_2": "APT 1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112053733",
            "telephone_number": "425-418-5342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 YORK AVE",
            "address_2": "FLOOR 4, SUITE 4",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100656007",
            "telephone_number": "212-639-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "SHANNON",
        "middle_name": "M",
        "credential": "BSN, FNP-BC, AOCNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-27",
        "last_updated": "2013-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "540332",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "335789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "KORTEKAAS",
            "middle_name": "M",
            "credential": "BSN, RN, OCN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James Joseph Andersen II, MD
• Kira Andersen, LCSW
• Micayla Paige Andersen
• Ryan Andersen
• Scott Michael Andersen, D.C.
• Susan M. Andersen, PH.D.
• Anderson Peak Performance Inc.
• Anderson Psychotherapy LCSW PLLC
• Latasha Anderson-Dunkley, NP
• Lizeth Anderson-Raciti

• Family Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.