Provider Demographics
NPI:1508275959
Name:SHANNON, ANDREW CAVALIERE (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CAVALIERE
Last Name:SHANNON
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SUMMER ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5358
Mailing Address - Country:US
Mailing Address - Phone:203-975-1545
Mailing Address - Fax:
Practice Address - Street 1:1250 SUMMER ST
Practice Address - Street 2:SUITE 204
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5358
Practice Address - Country:US
Practice Address - Phone:203-975-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist