Provider Demographics
NPI:1538648092
Name:STUBBS, SHAQUANDA SHARAY (LPN)
Entity Type:Individual
Prefix:
First Name:SHAQUANDA
Middle Name:SHARAY
Last Name:STUBBS
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 1:5 GABLE ALY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1327
Mailing Address - Country:US
Mailing Address - Phone:585-719-6842
Mailing Address - Fax:
Practice Address - Street 1:5 GABLE ALY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1327
Practice Address - Country:US
Practice Address - Phone:585-719-6842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3313291164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse