Provider Demographics
NPI:1982909792
Name:JOZWIAK SHIELDS, CONNIE JO (PHD, ANP)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:JO
Last Name:JOZWIAK SHIELDS
Suffix:
Gender:F
Credentials:PHD, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 MAIN STREET - SUITE 1
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-0000
Mailing Address - Country:US
Mailing Address - Phone:716-626-6320
Mailing Address - Fax:716-626-6324
Practice Address - Street 1:8201 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6046
Practice Address - Country:US
Practice Address - Phone:716-626-6320
Practice Address - Fax:716-626-6324
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3024851363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health