MRS. SHELLY C DILLENBURG (NPI# 1083233415) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083233415 |
| Entity Type | Individual |
| Full Name | MRS. SHELLY C DILLENBURG |
| Practice Address |
33 Church St Ste 3 Fredonia NY 14063-1761 |
| Practice Telephone | 7167856335 |
| Mailing Telephone | 7167856335 |
| Mailing Fax Number | 7167856138 |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2020-04-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
33 CHURCH ST STE 3 |
| City | FREDONIA |
| State | NY |
| Zip Code | 14063-1761 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932680501 | Michael Malory | Registered Nurse | 33 Church St Ste 3, Fredonia, NY 14063-1761 | 2018-08-22 |
| 1861017287 | Jenna Majka | Case Manager/Care Coordinator | 33 Church St Ste 3, Fredonia, NY 14063-1761 | 2020-06-11 |
| 1972157089 | Nechael Lewandowski | Registered Nurse | 33 Church St Ste 3, Fredonia, NY 14063-1761 | 2019-07-26 |
| 1699338111 | Margaret Rose Luther | Registered Nurse | 33 Church St Ste 3, Fredonia, NY 14063-1761 | 2019-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013516277 | Dawn J Manzella | Specialist | 135 W Mainn St, Fredonia, NY 14063 | 2020-10-20 |
| 1265909568 | Emily Marie Ludwig | Student in an Organized Health Care Education/Training Program | 3 Andrew Ct, Fredonia, NY 14063 | 2018-10-25 |
| 1275909129 | Diane Jo Rafan | Registered Nurse | 9705 Miller Rd, Fredonia, NY 14063 | 2015-08-14 |
| 1508281312 | Ann R Dutchess | Registered Nurse | Lakeside Clinic, 355 Central Ave, Fredonia, NY 14063 | 2014-03-03 |
| 1508134941 | Lauren Cecile Merlino | Speech-Language Pathologist | 9520 Fredonia-stockton Road, Lo Guidance Education Center, Fredonia, NY 14063 | 2011-12-13 |
| 1619287315 | Warren P. Sanderson | Registered Nurse | 264 East Main St, Fredonia, NY 14063 | 2010-10-15 |
| 1992020416 | Darwin's Health Club, Inc | Case Management | 47-53 Water Street, Fredonia, NY 14063 | 2010-03-29 |
| 1629255062 | Richard M Wright | Dentist | One Park Place, Suite #240, Fredonia, NY 14063 | 2008-01-29 |
| 1588845416 | Mark Twichell & Annette Lukasik Dds LLP | Dentist | 85 West Main Street, Fredonia, NY 14063 | 2007-11-20 |
| 1992911390 | Tracy Luise Stenger | Counselor | 105 Newton Street, Fredonia, NY 14063 | 2007-05-15 |
| Find all providers in zip 14063 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275917379 | Diedra Y Kinne | Peer Specialist | 240 West Jensen St., Fredonia, AZ 86022-0491 | 2015-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790385896 | Gary N/a Peluso | Peer Specialist | 62 Allan Dr, East Norwich, NY 11732-1203 | 2020-10-28 |
| 1043810138 | Ryan Hope Mcgovern | Peer Specialist | 950 S Oyster Bay Rd Bay Road, Hicksville, NY 11801-3510 | 2020-10-28 |
| 1669070207 | Sayeeda Zorita Daniels | Peer Specialist | 111 Woodlawn Ave Apt 2, Buffalo, NY 14209-1713 | 2020-10-15 |
| 1801409842 | Alexander Mannino | Peer Specialist | 419 Palisade Ave, Yonkers, NY 10703-2610 | 2020-08-28 |
| 1053924522 | Graham Joshua Anderson | Peer Specialist | 64 Linwood Ave., Buffalo, NY 14209 | 2020-08-25 |
| 1467064832 | Kenneth Robert Lewis | Peer Specialist | 320 N Goodman St Ste 202320, Rochester, NY 14607-1185 | 2020-08-18 |
| 1700404001 | Kathy Annett Gardini | Peer Specialist | 1914 Brookhaven Ave, Far Rockaway, NY 11691-3626 | 2020-07-13 |
| 1669099826 | Moseka Turkessa James | Peer Specialist | 1220 Remsen Ave # 1, Brooklyn, NY 11236-3925 | 2020-07-02 |
| 1174140545 | Mercedes Busby | Peer Specialist | 118 Brauncroft Ln, Amherst, NY 14226-4957 | 2020-07-01 |
| 1457977258 | Carla J Alomar | Peer Specialist | 414 Martin Rd, Lackawanna, NY 14218-2830 | 2020-06-18 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.