Provider Demographics
NPI:1508226697
Name:IPPOLITO, SHAWNA (BS)
Entity Type:Individual
Prefix:MISS
First Name:SHAWNA
Middle Name:
Last Name:IPPOLITO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 1/2 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2120
Mailing Address - Country:US
Mailing Address - Phone:716-467-1826
Mailing Address - Fax:
Practice Address - Street 1:423 1/2 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2120
Practice Address - Country:US
Practice Address - Phone:716-467-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist