Provider Demographics
NPI:1598796435
Name:NOWACKI, LAURA SHAW (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SHAW
Last Name:NOWACKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2122
Mailing Address - Country:US
Mailing Address - Phone:203-426-3267
Mailing Address - Fax:
Practice Address - Street 1:10 QUEEN ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2122
Practice Address - Country:US
Practice Address - Phone:203-426-3267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037490208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics