Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shannen Moore

Individual provider Pediatric Registered Nurse · NPI 1083092977

Shannen Moore is a Certified Registered Nurse Anesthetist (CRNA) in Boston, Massachusetts. Qualified in 2025, 1 year ago. Practices with Icahn School of Medicine at Mount Sinai, a 171-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
1
Licensed in
NY
In the registry since
2015
Specialties on file
3
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Practice location Address checks out

8 Waterman Rd
Boston, MA 02131-2218
Phone: (857) 345-0003
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Nurse Practitioner (primary) Taxonomy 363LP0200X · Licence 383018 (NY)
Pediatric Registered Nurse Taxonomy 163WP0200X · Licence 701502 (NY)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence 701502 (NY)

Record details

NPI number1083092977
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMay 11, 2015
Last updated in NPPESJanuary 27, 2026
Certification dateJanuary 27, 2026
Mailing address10 Monroe Blvd Apt 6f, Long Beach, NY 11561-4355

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Icahn School Of Medicine At Mount Sinai — 171 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Boston