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General NPI Number Information
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NPI Number | 1740926609
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Entity Type | Individual
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Provider Name | SHANNON MARIE MAHONEY
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Gender | Female
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Dates
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Enumeration Date | 05/12/2022
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 235 MAIN ST
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City | DANBURY
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State | CT
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Zip | 06810-6673
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Country | US
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Telephone | 203-730-5923
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Fax |
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Provider Business Mailing Address
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Address Line | 92 STUYVESANT DR
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-4225
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Country | US
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Telephone | 631-566-7543
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 044902
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 12442
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License Number State | CT
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