Basic Information
Provider Information
NPI: 1003142910
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KUZEL
FirstName: SHANNON
MiddleName: MICHELE
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 175 STAFFORD RD
Address2:  
City: MANSFIELD CENTER
State: CT
PostalCode: 062501441
CountryCode: US
TelephoneNumber: 8604568869
FaxNumber: 8604501936
Practice Location
Address1: 175 STAFFORD RD
Address2:  
City: MANSFIELD CENTER
State: CT
PostalCode: 062501441
CountryCode: US
TelephoneNumber: 8604568869
FaxNumber: 8604501936
Other Information
ProviderEnumerationDate: 10/28/2009
LastUpdateDate: 10/28/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171100000X000174CTY Other Service ProvidersAcupuncturist 
225700000X000174CTN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist 

No ID Information.


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