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NPI Code Detail

MEDICARE: SHANNON CLARKE

MEDICARE: SHANNON CLARKE
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
1225X00000XOccupational Therapist36503MA
2225X00000XOccupational Therapist028421NY

General Provider Information

NPI Number : 1518753300
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON CLARKE
Provider Business Mailing Address
First Line : 3 LAKEVIEW AVE
Second Line :
City : MASSAPEQUA
State : NY
Zip : 11758-5259
Country : US
Telephone Number : 516-780-4763
Fax Number :
Provider Business Practice Location Address
First Line : 146 PARK AVE
Second Line :
City : ARLINGTON
State : MA
Zip : 02476-5829
Country : US
Telephone Number : 781-648-9530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2025
Last Update Date : 02/13/2026

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Directions to “ SHANNON CLARKE ” Practice Location

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