Provider Demographics
NPI:1528946712
Name:BURKE, SHANNON (LCAT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-4028
Mailing Address - Country:US
Mailing Address - Phone:516-306-6585
Mailing Address - Fax:
Practice Address - Street 1:145 SUNRISE HWY STE 7
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2500
Practice Address - Country:US
Practice Address - Phone:516-254-9201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003030221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist