Provider Demographics
NPI:1083988711
Name:BETTS, SHAKENA CEOLA (LPN)
Entity Type:Individual
Prefix:
First Name:SHAKENA
Middle Name:CEOLA
Last Name:BETTS
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 1:138 E AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1847
Mailing Address - Country:US
Mailing Address - Phone:716-936-9268
Mailing Address - Fax:
Practice Address - Street 1:138 E AMHERST ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1847
Practice Address - Country:US
Practice Address - Phone:716-936-9268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse