Provider Demographics
NPI:1982302048
Name:BROWNELL, SHANNON MAY ROSE (LMT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MAY ROSE
Last Name:BROWNELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3443
Mailing Address - Country:US
Mailing Address - Phone:860-965-1280
Mailing Address - Fax:
Practice Address - Street 1:28 LAKEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3443
Practice Address - Country:US
Practice Address - Phone:860-965-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9953225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist