Healthcare Provider Details

I. General information

NPI: 1487896502
Provider Name (Legal Business Name): SHANNON M HALLIGAN L-CAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 ALEXANDER ST SUITE 200
ROCHESTER NY
14607-4007
US

IV. Provider business mailing address

215 ALEXANDER ST SUITE 200
ROCHESTER NY
14607-4007
US

V. Phone/Fax

Practice location:
  • Phone: 585-654-6646
  • Fax:
Mailing address:
  • Phone: 585-654-6646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number05 001193
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: