Provider Demographics
NPI:1164298188
Name:SHAUT, ROSALEE FAY
Entity Type:Individual
Prefix:
First Name:ROSALEE
Middle Name:FAY
Last Name:SHAUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 N HELMER AVE
Mailing Address - Street 2:
Mailing Address - City:DOLGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13329-1130
Mailing Address - Country:US
Mailing Address - Phone:315-882-1747
Mailing Address - Fax:
Practice Address - Street 1:46 N HELMER AVE
Practice Address - Street 2:
Practice Address - City:DOLGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13329-1130
Practice Address - Country:US
Practice Address - Phone:315-882-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258698164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse