Provider Demographics
NPI:1871857326
Name:WOZNIAK, SHANNAH DAWN
Entity Type:Individual
Prefix:MS
First Name:SHANNAH
Middle Name:DAWN
Last Name:WOZNIAK
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 1:13 STANHOPE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3107
Mailing Address - Country:US
Mailing Address - Phone:917-873-1674
Mailing Address - Fax:
Practice Address - Street 1:611 BROADWAY RM 907
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2630
Practice Address - Country:US
Practice Address - Phone:917-292-3958
Practice Address - Fax:212-437-4714
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist