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General NPI Number Information
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NPI Number | 1194363457
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Entity Type | Individual
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Provider Name | SHIANNE SHANAHAN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 9768 LIBERTY DR
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City | PAINTED POST
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State | NY
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Zip | 14870-9094
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Country | US
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Telephone | 607-937-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 404 W RIVER RD
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City | NICHOLS
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State | NY
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Zip | 13812-2109
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Country | US
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Telephone | 607-972-9138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 045351-01
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License Number State | NY
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