Provider Demographics
NPI:1699541342
Name:NOBLE, SHANNON ANDREA (LMT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ANDREA
Last Name:NOBLE
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 1:37 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4340
Mailing Address - Country:US
Mailing Address - Phone:860-816-9621
Mailing Address - Fax:
Practice Address - Street 1:35 COLD SPRING RD
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3160
Practice Address - Country:US
Practice Address - Phone:860-667-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006591225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist