Healthcare Provider Details

I. General information

NPI: 1881301729
Provider Name (Legal Business Name): SHAWN MARIE COACH SHAWN MARIE CICHOWSKI NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MAIN ST STE 313
WILLIAMSVILLE NY
14221-6737
US

IV. Provider business mailing address

5500 MAIN ST STE 313
WILLIAMSVILLE NY
14221-6737
US

V. Phone/Fax

Practice location:
  • Phone: 716-560-6552
  • Fax:
Mailing address:
  • Phone: 716-560-6552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3623791
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: