Healthcare Provider Details

I. General information

NPI: 1912198177
Provider Name (Legal Business Name): SHAWN EDWIN BREEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 BOSTON POST RD # UNITE210
GUILFORD CT
06437-4366
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 307
ISLANDIA NY
11749-5258
US

V. Phone/Fax

Practice location:
  • Phone: 203-533-6330
  • Fax: 475-209-8048
Mailing address:
  • Phone: 631-580-5222
  • Fax: 860-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11214
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number000663
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: