Provider Demographics
NPI:1427478346
Name:RAIMONDO, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:RAIMONDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 E COLORADO BLVD STE 560
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2380
Mailing Address - Country:US
Mailing Address - Phone:855-295-3276
Mailing Address - Fax:800-819-7806
Practice Address - Street 1:5266 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3707
Practice Address - Country:US
Practice Address - Phone:855-295-3276
Practice Address - Fax:800-819-7806
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001279103K00000X
NJ1-13-14477103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst