Provider Demographics
NPI:1477269819
Name:SZAJKOWKSA, BOZENA
Entity Type:Individual
Prefix:
First Name:BOZENA
Middle Name:
Last Name:SZAJKOWKSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SAUGATUCK AVE APT A
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5753
Mailing Address - Country:US
Mailing Address - Phone:203-273-2387
Mailing Address - Fax:
Practice Address - Street 1:9 W PROSPECT AVE STE 309
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2049
Practice Address - Country:US
Practice Address - Phone:914-699-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29617101364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health