Provider Demographics
NPI:1467680702
Name:STANBURY, SHANTE DENISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHANTE
Middle Name:DENISE
Last Name:STANBURY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:SHANTE
Other - Middle Name:DENISE
Other - Last Name:ORANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:96 BIDWELL TERRACE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613
Mailing Address - Country:US
Mailing Address - Phone:585-694-2426
Mailing Address - Fax:
Practice Address - Street 1:567 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624
Practice Address - Country:US
Practice Address - Phone:585-899-3571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264731-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse