Provider Demographics
NPI:1699769216
Name:KAZNOSKI, SHANA R (DO)
Entity type:Individual
Prefix:DR
First Name:SHANA
Middle Name:R
Last Name:KAZNOSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 SHEPHERDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-0500
Mailing Address - Country:US
Mailing Address - Phone:304-264-9332
Mailing Address - Fax:
Practice Address - Street 1:1178 SHEPHERDSTOWN RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-0500
Practice Address - Country:US
Practice Address - Phone:304-264-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2357208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics