Provider Demographics
NPI:1508154535
Name:MASSEY, SHARAE GWENDOLYN (LPN)
Entity Type:Individual
Prefix:
First Name:SHARAE
Middle Name:GWENDOLYN
Last Name:MASSEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MARIGOLD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-3626
Mailing Address - Country:US
Mailing Address - Phone:585-309-5650
Mailing Address - Fax:
Practice Address - Street 1:1 MARIGOLD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-3626
Practice Address - Country:US
Practice Address - Phone:585-309-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286091164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse