Provider Demographics
NPI:1437987500
Name:MONK, SHANNON FRAZEE (FNP-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:FRAZEE
Last Name:MONK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9619
Mailing Address - Country:US
Mailing Address - Phone:315-546-5326
Mailing Address - Fax:
Practice Address - Street 1:2880 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9619
Practice Address - Country:US
Practice Address - Phone:315-546-5326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF354206-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily