Provider Demographics
NPI:1982221453
Name:FEDAK, SHAUNA LEE (CRS)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:LEE
Last Name:FEDAK
Suffix:
Gender:F
Credentials:CRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CENTURY BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3692
Mailing Address - Country:US
Mailing Address - Phone:615-425-0225
Mailing Address - Fax:
Practice Address - Street 1:100 N WILKES BARRE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-5240
Practice Address - Country:US
Practice Address - Phone:570-846-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist