Provider Demographics
NPI:1629945860
Name:ALT, SHAWNA LEIGH
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LEIGH
Last Name:ALT
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 1:2681 TWO ROD RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-9667
Mailing Address - Country:US
Mailing Address - Phone:716-961-8360
Mailing Address - Fax:
Practice Address - Street 1:2681 TWO ROD RD
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-9667
Practice Address - Country:US
Practice Address - Phone:716-961-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula