Provider Demographics
NPI:1104236181
Name:MANIERO, SHANTAY FELICIA (MASSAGE THERAPIT)
Entity type:Individual
Prefix:MS
First Name:SHANTAY
Middle Name:FELICIA
Last Name:MANIERO
Suffix:
Gender:F
Credentials:MASSAGE THERAPIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-0503
Mailing Address - Country:US
Mailing Address - Phone:978-201-5022
Mailing Address - Fax:
Practice Address - Street 1:10 TOWER OFFICE PARK
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4711
Practice Address - Country:US
Practice Address - Phone:978-201-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12312225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist