Provider Demographics
NPI:1033660337
Name:O'CONNELL, SHAHEEN (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHAHEEN
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:SHAHEEN
Other - Middle Name:
Other - Last Name:O'CONNELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:74 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-2024
Mailing Address - Country:US
Mailing Address - Phone:914-906-9521
Mailing Address - Fax:
Practice Address - Street 1:74 LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-2024
Practice Address - Country:US
Practice Address - Phone:914-906-9521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292104164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse