Individual
KIERAN J SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3330 VETERANS MEMORIAL HWY, BOHEMIA, NY 11716-1036
(631) 672-2854
Mailing address
3129 WILSHIRE LN, OAKDALE, NY 11769-1441
(631) 672-2854
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
032022
NY
Other
Enumeration date
02/09/2020
Last updated
02/09/2020
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