MEDICARE: SHANNON DENAE TRAVERSINO LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	24605	OR

General Provider Information

NPI Number	:	1306778584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON DENAE TRAVERSINO LMT

Provider Business Mailing Address
First Line	:	7515 N FENWICK AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5513
Country	:	US
Telephone Number	:	818-679-4583
Fax Number	:

Provider Business Practice Location Address
First Line	:	7515 N FENWICK AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5513
Country	:	US
Telephone Number	:	818-679-4583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ SHANNON DENAE TRAVERSINO LMT” Practice Location

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