Provider Demographics
NPI:1437119773
Name:SHANLEY, JEFFREY P (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:P
Last Name:SHANLEY
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LONDON DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2933
Mailing Address - Country:US
Mailing Address - Phone:203-507-2654
Mailing Address - Fax:
Practice Address - Street 1:300 BOSTON POST RD
Practice Address - Street 2:CHARGER GYMNASIUM
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1916
Practice Address - Country:US
Practice Address - Phone:203-932-7407
Practice Address - Fax:203-932-7458
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer