Individual
SHANA NICOLE PETTWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
145 FITCH ST, NORTH HAVEN, CT 06473-3706
(203) 239-2564
Mailing address
66 SMITH ST FL 1, DERBY, CT 06418-1218
(203) 997-3610
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/30/2019
Last updated
12/30/2019
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