Provider Demographics
NPI:1346017993
Name:PELCHER-RAO, SHANNON (MT-BC, LCAT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:PELCHER-RAO
Suffix:
Gender:F
Credentials:MT-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 VARICK ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4606
Mailing Address - Country:US
Mailing Address - Phone:917-710-3406
Mailing Address - Fax:
Practice Address - Street 1:180 VARICK ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4606
Practice Address - Country:US
Practice Address - Phone:718-838-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002300225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist