MEDICARE: SHANNON O'CONNELL

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	225X00000X	Occupational Therapist	012941	NY

General Provider Information

NPI Number	:	1952655151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON O'CONNELL

Provider Business Mailing Address
First Line	:	56 BURNSIDE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-2301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 BURNSIDE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-2301
Country	:	US
Telephone Number	:	718-984-9800
Fax Number	:

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

Provider Enumeration Date	:	11/09/2012
Last Update Date	:	11/09/2012

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Directions to “ SHANNON O'CONNELL ” Practice Location

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