Provider Demographics
NPI:1619284825
Name:FOX, SHAWNA M (SPEECH THERAPIST)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:M
Last Name:FOX
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:M
Other - Last Name:SYNAKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2209 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-798-8361
Mailing Address - Fax:315-798-8397
Practice Address - Street 1:9601 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLLAND PATENT
Practice Address - State:NY
Practice Address - Zip Code:13354-4618
Practice Address - Country:US
Practice Address - Phone:315-865-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019921-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist