Provider Demographics
NPI:1578928636
Name:SHANAHAN, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SPECIAL EDUCATI
Mailing Address - Street 1:84 PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2517
Mailing Address - Country:US
Mailing Address - Phone:516-616-9030
Mailing Address - Fax:
Practice Address - Street 1:84 PRIMROSE AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2517
Practice Address - Country:US
Practice Address - Phone:516-616-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency