Healthcare Provider Details

I. General information

NPI: 1336004621
Provider Name (Legal Business Name): SHAWN DILLON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LONGWOOD RD
MIDDLE ISLAND NY
11953-2000
US

IV. Provider business mailing address

163 FLOWER HILL DR
SHIRLEY NY
11967-1424
US

V. Phone/Fax

Practice location:
  • Phone: 631-345-9200
  • Fax:
Mailing address:
  • Phone: 631-345-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: