Provider Demographics
NPI:1528178605
Name:SHUTLER, SANDRA JONES (RN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JONES
Last Name:SHUTLER
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 1:5153 STATE ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:NY
Mailing Address - Zip Code:12917
Mailing Address - Country:US
Mailing Address - Phone:518-483-5565
Mailing Address - Fax:
Practice Address - Street 1:155 FINNEY BLVD
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953
Practice Address - Country:US
Practice Address - Phone:518-483-0109
Practice Address - Fax:518-483-0115
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168842-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse