Provider Demographics
NPI:1083872170
Name:CONCEPCION, SHALUNDA MICHELE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHALUNDA
Middle Name:MICHELE
Last Name:CONCEPCION
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 1:110 TEABERRY DR
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1726
Mailing Address - Country:US
Mailing Address - Phone:585-730-2266
Mailing Address - Fax:
Practice Address - Street 1:110 TEABERRY DR
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1726
Practice Address - Country:US
Practice Address - Phone:585-820-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2822067164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse