Provider Demographics
NPI:1053987362
Name:MAYI, SHANNON MARIE (RN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:MAYI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:SLATTERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:57 ATHERTON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-1904
Mailing Address - Country:US
Mailing Address - Phone:781-913-6170
Mailing Address - Fax:
Practice Address - Street 1:57 ATHERTON AVE
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-1904
Practice Address - Country:US
Practice Address - Phone:781-913-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2259796163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse