Provider Demographics
NPI:1518911171
Name:FIORENTINO, SHAUNA KIMBERLY (OTR L CHT)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:KIMBERLY
Last Name:FIORENTINO
Suffix:
Gender:F
Credentials:OTR L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11801 INDUSTRIAL PARK ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-5139
Mailing Address - Country:US
Mailing Address - Phone:301-729-3485
Mailing Address - Fax:301-729-0158
Practice Address - Street 1:11801 INDUSTRIAL PARK ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-5139
Practice Address - Country:US
Practice Address - Phone:301-729-3485
Practice Address - Fax:301-729-0158
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03939225X00000X
PA1031100071225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004OtherCAREFIRST BCBS OF DC NCA
MD68649905OtherBLUECROSS BLUESHIELD
5454765OtherAETNA
WV9420176000Medicaid
WV1017320OtherWORKERS COMPENSATION
273688OtherMAMSI
650017269OtherRAILROAD MEDICARE
WV9420176000Medicaid