Provider Demographics
NPI:1821971870
Name:CITRENBAUM, SHANE PATRICK
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:PATRICK
Last Name:CITRENBAUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LOVALEE LN
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19373-1053
Mailing Address - Country:US
Mailing Address - Phone:610-357-9116
Mailing Address - Fax:
Practice Address - Street 1:12 LOVALEE LN
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:PA
Practice Address - Zip Code:19373-1053
Practice Address - Country:US
Practice Address - Phone:610-357-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer