Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MD471279 | PA |
NPI | 1245657451 |
---|---|
Provider Name | Jennifer Kosoy Shook |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2014 |
Last Update Date | 29/07/2020 |