Healthcare Provider Details

I. General information

NPI: 1700663317
Provider Name (Legal Business Name): SHANNON LEIGH LIGUORI MS.ED CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 CORPORATE CIR
ALBANY NY
12203-5176
US

IV. Provider business mailing address

52 CORPORATE CIR
ALBANY NY
12203-5176
US

V. Phone/Fax

Practice location:
  • Phone: 518-456-3268
  • Fax:
Mailing address:
  • Phone: 518-456-3268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1739479231
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: