Provider Demographics
NPI:1427310960
Name:MCGUIGAN, SHANNON PRIVEE (LMT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:PRIVEE
Last Name:MCGUIGAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 PETTINGILL ROAD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4542
Mailing Address - Country:US
Mailing Address - Phone:207-415-6725
Mailing Address - Fax:
Practice Address - Street 1:234 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1220
Practice Address - Country:US
Practice Address - Phone:207-415-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4761225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist