Provider Demographics
NPI:1982949376
Name:BLAISS, SHOSHANAH (MSN, CNM, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:SHOSHANAH
Middle Name:
Last Name:BLAISS
Suffix:
Gender:F
Credentials:MSN, CNM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4395 WINDSONG CT SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4239
Mailing Address - Country:US
Mailing Address - Phone:404-458-7137
Mailing Address - Fax:470-435-6493
Practice Address - Street 1:4395 WINDSONG CT SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-4239
Practice Address - Country:US
Practice Address - Phone:404-458-7137
Practice Address - Fax:470-435-6493
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN196459163W00000X, 163WL0100X, 367A00000X
174H00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula