Healthcare Provider Details

I. General information

NPI: 1376366385
Provider Name (Legal Business Name): SHAUNA LEIGH DELONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N 3RD ST
HARRISBURG PA
17110-1904
US

IV. Provider business mailing address

2501 N 3RD ST
HARRISBURG PA
17110-1904
US

V. Phone/Fax

Practice location:
  • Phone: 717-782-2750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH070123
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: