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SHANNON PHAN
NPI 1063368272
Counselor - Mental Health in Fayetteville, NY

Active since March 09, 2026
4000 MEDICAL CENTER DRIVE, SUITE 504, FAYETTEVILLE, NY 13066(315) 329-2650 Get Directions Write a Review

NPPES record last updated: March 9, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Shannon Phan NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANNON PHAN (NPI 1063368272) is an individual mental health provider in Fayetteville, New York, licensed in New York (P133718) and active in the NPI registry since March 2026.

NPPES Registry Identity

NPI1063368272
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameSHANNON PHAN
Location Address4000 MEDICAL CENTER DRIVE, SUITE 504Fayetteville, NY 13066
Mailing Address8584 Mcnamara DrClay, NY 13041-8819 · (315) 414-1252
Phone(315) 329-2650
Sole ProprietorYes
Enumeration DateMarch 9, 2026
NPPES CertifiedMarch 5, 2026
✔ NPI 1063368272 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in NY · P133718
4000 MEDICAL CENTER DRIVE, Fayetteville, NY 13066
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BIBY RAJAN-GEORGE M.D PLLC
Internal Medicine
4000 MEDICAL CENTER DRIVE
FAYETTEVILLE, NY 13066
Onondaga County (315) 637-2665
SYRACUSE FAMILY CHIROPRACTIC LLC
Chiropractor
4000 MEDICAL CENTER DRIVE, SUITE 301
FAYETTEVILLE, NY 13066
Onondaga County (315) 761-6311
SYRACUSE SUPPLY INC
Durable Medical Equipment & Medical Supplies
4000 MEDICAL CENTER DRIVE, SUITE 301
FAYETTEVILLE, NY 13066
Onondaga County (315) 373-9834
JUSTIN IORIO M.D.
Orthopaedic Surgery (Orthopaedic Surgery of the Spine)
4000 MEDICAL CENTER DRIVE, SUITE 115
FAYETTEVILLE, NY 13066
Onondaga County (315) 329-2555
VITKUS, SCUTARI & CARDOSO ORAL SURGERY PC
Dentist (Oral and Maxillofacial Surgery)
4000 MEDICAL CENTER DRIVE, SUITE B13
FAYETTEVILLE, NY 13066
Onondaga County (315) 671-4289
AUBREY LYNN MORRIS NP
Nurse Practitioner (Family)
4000 MEDICAL CENTER DRIVE, SUITE 117
FAYETTEVILLE, NY 13066
Onondaga County (315) 744-1551
CHRISTINE HARRIS
Student in an Organized Health Care Education/Training Program
4000 MEDICAL CENTER DRIVE, SUITE 502
FAYETTEVILLE, NY 13066
Onondaga County (315) 703-2780
KAYLA DUSSING FNP-C
Nurse Practitioner (Family)
4000 MEDICAL CENTER DRIVE, SUITE 402
FAYETTEVILLE, NY 13066
Onondaga County (315) 663-0005

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shannon Phan's NPI number?

The NPI number for Shannon Phan is 1063368272. It was assigned to this individual provider in the NPPES registry on March 9, 2026.

Where is Shannon Phan located?

Shannon Phan practices at 4000 Medical Center Drive Suite 504, Fayetteville, NY 13066. The listed phone number is (315) 329-2650.

What is Shannon Phan's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Shannon Phan was last updated on March 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.