Provider Demographics
NPI:1740038801
Name:SZATKOWSKI, SHANNON DIANE (LPN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:DIANE
Last Name:SZATKOWSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9740
Mailing Address - Country:US
Mailing Address - Phone:716-393-6710
Mailing Address - Fax:
Practice Address - Street 1:1543 MAIN RD
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036-9740
Practice Address - Country:US
Practice Address - Phone:716-393-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34111801164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse