Provider Demographics
NPI:1033743562
Name:CIPRIANO, SHANNA L (PTA)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:L
Last Name:CIPRIANO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:L
Other - Last Name:BUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:74 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:ME
Mailing Address - Zip Code:04912-4627
Mailing Address - Country:US
Mailing Address - Phone:207-399-4985
Mailing Address - Fax:
Practice Address - Street 1:57 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1414
Practice Address - Country:US
Practice Address - Phone:207-474-7000
Practice Address - Fax:207-858-4772
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA3311225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant