Provider Demographics
NPI:1902041890
Name:SHANER, DEIRDRE ANNE
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:ANNE
Last Name:SHANER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DEIRDRE
Other - Middle Name:SHANER
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3 PARTRICK LN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-1832
Mailing Address - Country:US
Mailing Address - Phone:203-454-9579
Mailing Address - Fax:
Practice Address - Street 1:20 CEDAR ST
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5247
Practice Address - Country:US
Practice Address - Phone:914-576-5292
Practice Address - Fax:914-576-3983
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007967-1225X00000X
CT002175225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist