Provider Demographics
NPI:1154082204
Name:DEVEAUX, SHANA LEAH
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:LEAH
Last Name:DEVEAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:LEAH
Other - Last Name:OROURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:236 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-4022
Mailing Address - Country:US
Mailing Address - Phone:518-322-6095
Mailing Address - Fax:
Practice Address - Street 1:236 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-4022
Practice Address - Country:US
Practice Address - Phone:518-322-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-31
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2348440163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse