Provider Demographics
NPI:1558671347
Name:MCLOUGHLIN, SHANNON (MA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 PECONIC TER
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933-9788
Mailing Address - Country:US
Mailing Address - Phone:631-466-2443
Mailing Address - Fax:
Practice Address - Street 1:2060 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2009
Practice Address - Country:US
Practice Address - Phone:718-822-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist