Provider Demographics
NPI:1740777069
Name:PERRY, SHONDELLE E (LMT)
Entity Type:Individual
Prefix:
First Name:SHONDELLE
Middle Name:E
Last Name:PERRY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 GAR HWY
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-3906
Mailing Address - Country:US
Mailing Address - Phone:508-375-3844
Mailing Address - Fax:508-375-3845
Practice Address - Street 1:1738 GAR HWY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3906
Practice Address - Country:US
Practice Address - Phone:508-375-3844
Practice Address - Fax:508-375-3845
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12823225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist