NPI 1790164648

Shannon Wong, LMT

Practitioner Contractor Portland, ME

Practice location

Address: 449 Forest Ave, Portland, ME 04101-2029
Phone: (207) 329-4386
Mailing address: 59 Saint George St, Portland, ME 04103-4019

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence MT4634 (ME)

Other Contractor providers in Maine →

Registry record

NPI: 1790164648
Entity type: Individual
Sex (as registered): Female
NPI issued: 26 May 2015
Record last updated: 26 May 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.