Shannon Vavalle, ATC, CES, OTC
Individual provider Active NPI Athletic Trainer · Vestal, NY
NPI 1801657309 · NPPES record last updated Jan 22, 2024
Key facts
- NPI
- 1801657309
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 020802088 (NY)
- Practice address
- 4433 Vestal Pkwy E
Vestal, NY 13850-3556 - Phone
- (607) 771-2220
- Fax
- (607) 251-2635
- NPI assigned
- Jan 22, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020802088 | NY | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 020802088 | NY | Yes |
Addresses
Primary practice location
4433 Vestal Pkwy E
Vestal, NY 13850-3556
Mailing address
4433 Vestal Pkwy E
Vestal, NY 13850-3556
Phone (607) 771-2220
Other providers in Vestal, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.