Provider Demographics
NPI:1467873364
Name:LABAGH-FRUNZI, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LABAGH-FRUNZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WIERK AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754
Mailing Address - Country:US
Mailing Address - Phone:845-295-4000
Mailing Address - Fax:
Practice Address - Street 1:17 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-1807
Practice Address - Country:US
Practice Address - Phone:845-292-4134
Practice Address - Fax:845-292-4134
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024298-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist