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

Shannon Phan

Individual provider Mental Health Counselor · NPI 1063368272

Shannon Phan is a Mental Health Counselor in Fayetteville, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2026

Practice location Address checks out

4000 Medical Center Dr Ste 504
Fayetteville, NY 13066
Phone: (315) 329-2650
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence P133718 (NY)

Record details

NPI number1063368272
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMarch 9, 2026
Last updated in NPPESMarch 9, 2026
Certification dateMarch 5, 2026
Mailing address8584 McNamara Dr, Clay, NY 13041-8819

Other providers in Fayetteville