Provider Demographics
NPI:1679233340
Name:MCNAMARA, SHANE PATRICK
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:PATRICK
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 GLENMAURA DR
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1921
Mailing Address - Country:US
Mailing Address - Phone:610-721-9243
Mailing Address - Fax:
Practice Address - Street 1:1755 N KEYSER AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1215
Practice Address - Country:US
Practice Address - Phone:570-343-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000002597237700000X
PAF02804237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1194043109OtherORGANIZATIONAL NPI
NY1679891972OtherORGANIZATIONAL NPI