Provider Demographics
NPI:1689021511
Name:GAWRONSKI, SHANNON (RN)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:GAWRONSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 KENT ST
Mailing Address - Street 2:LOWER APT.
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-1713
Mailing Address - Country:US
Mailing Address - Phone:716-517-1270
Mailing Address - Fax:
Practice Address - Street 1:845 ROUTE 5 AND 20
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9706
Practice Address - Country:US
Practice Address - Phone:716-951-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-614517163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse