Healthcare Provider Details

I. General information

NPI: 1215840277
Provider Name (Legal Business Name): SHAWNA MARIE DZIEDZIAK CD, CPD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 S AMBERS CIR
WASILLA AK
99654-0798
US

IV. Provider business mailing address

2980 S AMBERS CIR
WASILLA AK
99654-0798
US

V. Phone/Fax

Practice location:
  • Phone: 907-414-8523
  • Fax:
Mailing address:
  • Phone: 907-414-8523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number2238100
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: