Provider Demographics
NPI:1447025887
Name:ALBERT, SHANNON RACHAEL (MT-BC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:RACHAEL
Last Name:ALBERT
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIFFARD
Mailing Address - State:NY
Mailing Address - Zip Code:14533-9797
Mailing Address - Country:US
Mailing Address - Phone:716-474-8644
Mailing Address - Fax:
Practice Address - Street 1:80 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OAKFIELD
Practice Address - State:NY
Practice Address - Zip Code:14125-1241
Practice Address - Country:US
Practice Address - Phone:585-313-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18497225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist