Provider Demographics
NPI:1073760567
Name:AUSTIN, SHELLY L (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:L
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:LACONA
Mailing Address - State:NY
Mailing Address - Zip Code:13083-3109
Mailing Address - Country:US
Mailing Address - Phone:315-254-0930
Mailing Address - Fax:
Practice Address - Street 1:180 EDWARDS RD
Practice Address - Street 2:
Practice Address - City:LACONA
Practice Address - State:NY
Practice Address - Zip Code:13083-3109
Practice Address - Country:US
Practice Address - Phone:315-254-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226336-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse