Provider Demographics
NPI:1033610829
Name:RECORE, SHAWNA RENE CECELIA
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:RENE CECELIA
Last Name:RECORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 WINDFALL RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-8019
Mailing Address - Country:US
Mailing Address - Phone:315-717-2910
Mailing Address - Fax:
Practice Address - Street 1:9834 RIVER RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-2304
Practice Address - Country:US
Practice Address - Phone:315-717-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030197-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist