Provider Demographics
NPI:1992798227
Name:MANZO, SHANNON CHRISTINE (AUD)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:CHRISTINE
Last Name:MANZO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:CHRISTINE
Other - Last Name:RAYMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2561 LAC DE VILLE BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5645
Mailing Address - Country:US
Mailing Address - Phone:585-461-9192
Mailing Address - Fax:585-461-9196
Practice Address - Street 1:2561 LAC DE VILLE BLVD
Practice Address - Street 2:STE 101
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5645
Practice Address - Country:US
Practice Address - Phone:585-461-9192
Practice Address - Fax:585-461-9196
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001866231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD1097Medicare ID - Type Unspecified