Provider Demographics
NPI:1215342613
Name:QUINN, SHANAIRRA C
Entity type:Individual
Prefix:
First Name:SHANAIRRA
Middle Name:C
Last Name:QUINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61010-1464
Mailing Address - Country:US
Mailing Address - Phone:815-234-2511
Mailing Address - Fax:
Practice Address - Street 1:811 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-1464
Practice Address - Country:US
Practice Address - Phone:815-234-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
TX2145092225200000X
CA50261225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant