Individual
MISS SHANNON MARIE FITZGERALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
597 3RD AVE, TROY, NY 12182-2509
(518) 233-0544
(518) 233-0703
Mailing address
597 THIRD AVE, TROY, NY 12182
(518) 233-0544
(518) 233-0703
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
463013101
NY
Other
Enumeration date
06/14/2012
Last updated
06/14/2012
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