Healthcare Provider Details

I. General information

NPI: 1275428906
Provider Name (Legal Business Name): SHAWNEICIA RENEE CIULLA LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SCHILLER ST APT 1
BINGHAMTON NY
13905-3957
US

IV. Provider business mailing address

19 SCHILLER ST APT 1
BINGHAMTON NY
13905-3957
US

V. Phone/Fax

Practice location:
  • Phone: 607-245-6744
  • Fax:
Mailing address:
  • Phone: 607-245-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number350852
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: