Individual
SHANON DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED
Contact information
Practice address
50 RUSSELL ST APT 2A, PLYMOUTH, MA 02360-3974
(774) 454-9373
Mailing address
50 RUSSELL ST APT 2A, PLYMOUTH, MA 02360-3974
(774) 454-9373
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
08/12/2015
Last updated
08/12/2015
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