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General NPI Number Information
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NPI Number | 1598449431
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Entity Type | Individual
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Provider Name | SEAN PATRICK SHIMANSKY M. ED, BCBA, LABA
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Gender | Male
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 55 DEER PARK DR
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028-3198
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Country | US
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Telephone | 413-525-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 71 GREEN TREE LN
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City | SOMERS
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State | CT
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Zip | 06071-1211
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Country | US
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Telephone | 413-374-8779
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 529
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | LABA1750
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License Number State | MA
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