Provider Demographics
NPI:1235021783
Name:COSTANZO, SHAWN KUDRIK (RN)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:KUDRIK
Last Name:COSTANZO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:ELLEN
Other - Last Name:KUDRIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:62 DENVER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OLD FORT
Mailing Address - State:NC
Mailing Address - Zip Code:28762-9785
Mailing Address - Country:US
Mailing Address - Phone:828-779-2269
Mailing Address - Fax:
Practice Address - Street 1:62 DENVER RIDGE RD
Practice Address - Street 2:
Practice Address - City:OLD FORT
Practice Address - State:NC
Practice Address - Zip Code:28762-9785
Practice Address - Country:US
Practice Address - Phone:828-779-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC285954163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse