Provider Demographics
NPI:1114432010
Name:PATTERSON, SHAWNTEL TYRONE
Entity Type:Individual
Prefix:MR
First Name:SHAWNTEL
Middle Name:TYRONE
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 E SENECA TPKE APT B1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2617
Mailing Address - Country:US
Mailing Address - Phone:315-210-9355
Mailing Address - Fax:
Practice Address - Street 1:683 E SENECA TPKE APT B1
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2617
Practice Address - Country:US
Practice Address - Phone:315-210-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321750164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse