Provider Demographics
NPI:1770627994
Name:BESSETTE, SHANNON (PT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BESSETTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LATOUR AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-7206
Mailing Address - Country:US
Mailing Address - Phone:518-578-8753
Mailing Address - Fax:518-310-1170
Practice Address - Street 1:14 LATOUR AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-7206
Practice Address - Country:US
Practice Address - Phone:518-578-8753
Practice Address - Fax:518-310-1170
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141338471OtherACN
NY000490905001OtherBSNENY
NY0031884Medicaid