Provider Demographics
NPI:1679064695
Name:MCELROY, SHANNON E (PMHNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:MCELROY
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:E
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:69 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-9145
Mailing Address - Country:US
Mailing Address - Phone:609-760-0957
Mailing Address - Fax:
Practice Address - Street 1:550 BROAD ST STE 606
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-4537
Practice Address - Country:US
Practice Address - Phone:201-822-1161
Practice Address - Fax:877-485-8918
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023459363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid
NJ0955086Medicaid