Provider Demographics
NPI:1417306796
Name:WINSLOW, SHAUGHNA SZYMANSKI (DDS)
Entity Type:Individual
Prefix:
First Name:SHAUGHNA
Middle Name:SZYMANSKI
Last Name:WINSLOW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-0003
Mailing Address - Country:US
Mailing Address - Phone:315-589-2813
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 3
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589
Practice Address - Country:US
Practice Address - Phone:315-589-2813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0593211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program