MEDICARE: MR. SHAWN PATRICK CONNELLY SLP-CCC

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	235Z00000X	Speech-Language Pathologist	6520	MA

General Provider Information

NPI Number	:	1952304172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN PATRICK CONNELLY SLP-CCC

Provider Business Mailing Address
First Line	:	84A COCASSET ST
Second Line	:	# A-4
City	:	FOXBORO
State	:	MA
Zip	:	02035-2035
Country	:	US
Telephone Number	:	617-275-9023
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 OAK ST
Second Line	:
City	:	FRANKLIN
State	:	MA
Zip	:	02038-1875
Country	:	US
Telephone Number	:	508-541-7890
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. SHAWN PATRICK CONNELLY SLP-CCC” Practice Location

Language	Start Address	Practice Location

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