Individual
SHANNON NINAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 BROADHOLLOW RD, MELVILLE, NY 11747-4822
(631) 385-7780
Mailing address
11 MYERS AVE, HICKSVILLE, NY 11801-2522
(516) 853-1744
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/14/2019
Last updated
02/14/2019
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