Provider Demographics
NPI:1134677966
Name:SHANAHAN-ROBERGE, DOROTHY (BA, RN)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:SHANAHAN-ROBERGE
Suffix:
Gender:F
Credentials:BA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 ULSTER AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1344
Mailing Address - Country:US
Mailing Address - Phone:845-339-6683
Mailing Address - Fax:
Practice Address - Street 1:918 ULSTER AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1344
Practice Address - Country:US
Practice Address - Phone:845-339-6683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY667415163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health