Provider Demographics
NPI:1487483053
Name:MUNOZ, SHEENA A
Entity type:Individual
Prefix:MRS
First Name:SHEENA
Middle Name:A
Last Name:MUNOZ
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:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-0608
Mailing Address - Country:US
Mailing Address - Phone:518-483-1251
Mailing Address - Fax:518-483-2242
Practice Address - Street 1:650 SATE STREET
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1251
Practice Address - Country:US
Practice Address - Phone:313-755-1251
Practice Address - Fax:315-291-6601
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist