Provider Demographics
NPI:1346533288
Name:JESCH, SHANNA (IBCLC RLC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:
Last Name:JESCH
Suffix:
Gender:F
Credentials:IBCLC RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 BROOKTONDALE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:14817-9513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:172 BROOKTONDALE RD
Practice Address - Street 2:
Practice Address - City:BROOKTONDALE
Practice Address - State:NY
Practice Address - Zip Code:14817-9513
Practice Address - Country:US
Practice Address - Phone:607-257-4073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN