Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | NY |
NPI | 1083121180 |
---|---|
Provider Name | Shannyn Sarah Dewey |
First Address | Hawthorne, NY 10532-2140 |
Second Address | Kingston, NY 12401-5151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2018 |
Last Update Date | 02/03/2020 |