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NPI Code Detail

MEDICARE: JESSICA SHANAHAN IX

MEDICARE: JESSICA SHANAHAN IX
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist026953NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942303896
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA SHANAHAN IX
Provider Business Mailing Address
First Line : PO BOX 187
Second Line : ROUTE 9 GRAND UNION PLAZA
City : VALATIE
State : NY
Zip : 12184-0187
Country : US
Telephone Number : 518-758-7616
Fax Number :
Provider Business Practice Location Address
First Line : 10B MADISON AVENUE EXT
Second Line :
City : ALBANY
State : NY
Zip : 12203-7314
Country : US
Telephone Number : 518-867-3061
Fax Number : 518-867-3066
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2006
Last Update Date : 12/22/2022

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