Healthcare Provider Details

I. General information

NPI: 1982909792
Provider Name (Legal Business Name): CONNIE JO JOZWIAK SHIELDS PH.D., ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 MAIN ST STE 1
WILLIAMSVILLE NY
14221-6046
US

IV. Provider business mailing address

8201 MAIN STREET - SUITE 1
WILLIAMSVILLE NY
14221-0000
US

V. Phone/Fax

Practice location:
  • Phone: 716-626-6320
  • Fax: 716-626-6324
Mailing address:
  • Phone: 716-626-6320
  • Fax: 716-626-6324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3024851
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: