Provider Demographics
NPI:1437671641
Name:SHANAHAN, CAILIN MARIE (AUD)
Entity Type:Individual
Prefix:
First Name:CAILIN
Middle Name:MARIE
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 GOVERNOR MANLY WAY
Mailing Address - Street 2:STE 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7382
Mailing Address - Country:US
Mailing Address - Phone:267-614-6152
Mailing Address - Fax:
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1868
Practice Address - Country:US
Practice Address - Phone:781-216-3877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4692231H00000X
NC14775231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist