Provider Demographics
NPI:1972331304
Name:PUCCIO, SHAUNA ELIZABETH (AUD)
Entity type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:ELIZABETH
Last Name:PUCCIO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MALDEN DR
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-5539
Mailing Address - Country:US
Mailing Address - Phone:631-905-8978
Mailing Address - Fax:
Practice Address - Street 1:378 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2200
Practice Address - Country:US
Practice Address - Phone:732-226-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003257-01231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist