Healthcare Provider Details

I. General information

NPI: 1891445334
Provider Name (Legal Business Name): SHANZA NOEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2022
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6355
  • Fax: 570-271-5788
Mailing address:
  • Phone: 570-271-6355
  • Fax: 570-271-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS045339
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: