Provider Demographics
NPI:1053922799
Name:KUSNIERZ, SHELLEY E
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:E
Last Name:KUSNIERZ
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 1:501 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2306
Mailing Address - Country:US
Mailing Address - Phone:413-746-1563
Mailing Address - Fax:
Practice Address - Street 1:501 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2306
Practice Address - Country:US
Practice Address - Phone:413-746-1563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist