Provider Demographics
NPI:1801395694
Name:FLAHERTY, SHANNON (MT-BC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2300
Mailing Address - Country:US
Mailing Address - Phone:781-224-3300
Mailing Address - Fax:781-224-3306
Practice Address - Street 1:333 NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2300
Practice Address - Country:US
Practice Address - Phone:781-224-3300
Practice Address - Fax:781-224-3306
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13387225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist