Provider Demographics
NPI:1588946818
Name:KEREKES, SHANNON L (MS OTR/L)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:L
Last Name:KEREKES
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5612
Practice Address - Country:US
Practice Address - Phone:631-499-1237
Practice Address - Fax:631-499-1074
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016953225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist