Provider Demographics
NPI:1912198177
Name:BREEN, SHAWN EDWIN (PT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:EDWIN
Last Name:BREEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5222
Mailing Address - Fax:860-760-8306
Practice Address - Street 1:1919 BOSTON POST RD # UNITE210
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-4366
Practice Address - Country:US
Practice Address - Phone:203-533-6330
Practice Address - Fax:475-209-8048
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000663225200000X
CT11214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant