Provider Demographics
NPI:1447408687
Name:BRISCOE, SHANTAL R (RN)
Entity Type:Individual
Prefix:MS
First Name:SHANTAL
Middle Name:R
Last Name:BRISCOE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CLINTON ST
Mailing Address - Street 2:APT 10
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-1454
Mailing Address - Country:US
Mailing Address - Phone:585-226-6999
Mailing Address - Fax:
Practice Address - Street 1:180 CLINTON ST
Practice Address - Street 2:APT 10
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414-1454
Practice Address - Country:US
Practice Address - Phone:585-226-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY550117-1163W00000X, 163WM0102X, 163WW0101X, 163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163W00000XNursing Service ProvidersRegistered Nurse
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient