Provider Demographics
NPI:1134499031
Name:PATTON, IRASH SHENESHA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:IRASH
Middle Name:SHENESHA
Last Name:PATTON
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 1:60 COURTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3919
Mailing Address - Country:US
Mailing Address - Phone:716-310-1779
Mailing Address - Fax:
Practice Address - Street 1:60 COURTLAND AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3919
Practice Address - Country:US
Practice Address - Phone:716-310-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 306117164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse