Provider Demographics
NPI:1730548132
Name:SANTUCCIONE, SHAWNA (MS OTR/L)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:SANTUCCIONE
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:1388 DUNNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306-5509
Mailing Address - Country:US
Mailing Address - Phone:518-210-9622
Mailing Address - Fax:
Practice Address - Street 1:31 NICHOLAS DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2527
Practice Address - Country:US
Practice Address - Phone:518-210-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63 020459225X00000X
NY020459-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist