Healthcare Provider Details

I. General information

NPI: 1972331304
Provider Name (Legal Business Name): SHAUNA ELIZABETH PUCCIO AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 SEAVIEW AVE
STATEN ISLAND NY
10305-2200
US

IV. Provider business mailing address

900 MALDEN DR
KEYPORT NJ
07735-5539
US

V. Phone/Fax

Practice location:
  • Phone: 732-226-6110
  • Fax:
Mailing address:
  • Phone: 631-905-8978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number003257-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: