Provider Demographics
NPI:1710958871
Name:KOSNIK, SHAWN D (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:D
Last Name:KOSNIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 THE VILLAGE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-2616
Mailing Address - Country:US
Mailing Address - Phone:828-586-7474
Mailing Address - Fax:828-586-7473
Practice Address - Street 1:38 THE VILLAGE OVERLOOK
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2616
Practice Address - Country:US
Practice Address - Phone:828-586-7474
Practice Address - Fax:828-586-7473
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800301207YS0123X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2319276OtherMEDICARE
NC890207RMedicaid