Provider Demographics
NPI:1336816461
Name:REILLY, SHANNON RITA (SLP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RITA
Last Name:REILLY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 RADCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-2519
Mailing Address - Country:US
Mailing Address - Phone:914-539-5269
Mailing Address - Fax:
Practice Address - Street 1:3044 RADCLIFFE DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-2519
Practice Address - Country:US
Practice Address - Phone:914-539-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist