Provider Demographics
NPI:1316577984
Name:HENRY GORDON, SHANALEE
Entity Type:Individual
Prefix:
First Name:SHANALEE
Middle Name:
Last Name:HENRY GORDON
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 1:205 SOUTH AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4823
Mailing Address - Country:US
Mailing Address - Phone:845-518-8164
Mailing Address - Fax:
Practice Address - Street 1:205 SOUTH AVE STE 108
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4823
Practice Address - Country:US
Practice Address - Phone:845-518-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion