Provider Demographics
NPI:1619015757
Name:RECK, SHANNON PAUL (HS, IDMT)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:PAUL
Last Name:RECK
Suffix:
Gender:M
Credentials:HS, IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2756
Mailing Address - Country:US
Mailing Address - Phone:207-318-2145
Mailing Address - Fax:207-741-5470
Practice Address - Street 1:259 HIGH STREET
Practice Address - Street 2:US COAST GUARD SECTOR NORTHERN NEW ENGLAND
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-767-0339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other