Provider Demographics
NPI:1083802474
Name:SAKOWSKI, SHANNON ERICA (RN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ERICA
Last Name:SAKOWSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N FULTON ST
Mailing Address - Street 2:APT. 407
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2200
Mailing Address - Country:US
Mailing Address - Phone:973-743-3295
Mailing Address - Fax:
Practice Address - Street 1:110 NORTH FULTON STREET
Practice Address - Street 2:APT. 407
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003
Practice Address - Country:US
Practice Address - Phone:973-743-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA589109163W00000X
NJ26NR11127400163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse