MEDICARE: DR. JOHN JOSEPH SHALANSKI DSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW013630	PA

General Provider Information

NPI Number	:	1700810215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN JOSEPH SHALANSKI DSW

Provider Business Mailing Address
First Line	:	90 BENJAMIN AVE
Second Line	:
City	:	CONYNGHAM
State	:	PA
Zip	:	18219-0006
Country	:	US
Telephone Number	:	570-788-4321
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 BENJAMIN AVE
Second Line	:
City	:	CONYNGHAM
State	:	PA
Zip	:	18219-0006
Country	:	US
Telephone Number	:	570-788-4321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	06/24/2008

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