Individual provider · Type 1 NPI

Shannon Kennedy

Student in an Organized Health Care Education/Training Program · Smithtown, NY

NPI number 1104735067 Active

Practice location

11 NY-111
Smithtown, NY 11787

Call (631) 920-8050 Map

Mailing address

11 Route 111
Smithtown, NY 11787-3754

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1104735067

Shannon Kennedy's National Provider Identifier is 1104735067, issued on Sep 4, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Smithtown, NY. The record was last updated on Sep 4, 2026.