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General NPI Number Information
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NPI Number | 1821352477
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Entity Type | Individual
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Provider Name | SHANNON MOYNIHAN
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Gender | Female
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 147 W 86TH ST APT 1A
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City | NEW YORK
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State | NY
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Zip | 10024-3416
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Country | US
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Telephone | 203-605-0246
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Fax |
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Provider Business Mailing Address
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Address Line | 147 W 86TH ST APT 1A
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City | NEW YORK
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State | NY
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Zip | 10024-3416
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Country | US
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Telephone | 203-605-0246
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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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 | 002938
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License Number State | NY
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