Provider Demographics
NPI:1831512532
Name:SHANINE, TONI MIQUEL (MT-BC, LPMT)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:MIQUEL
Last Name:SHANINE
Suffix:
Gender:F
Credentials:MT-BC, LPMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-4247
Mailing Address - Country:US
Mailing Address - Phone:678-936-4269
Mailing Address - Fax:770-287-1932
Practice Address - Street 1:605 WEST AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-4247
Practice Address - Country:US
Practice Address - Phone:678-936-4269
Practice Address - Fax:770-287-1932
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMUT000083225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist